"BusinessYear","StateCode","IssuerId","SourceName","VersionNum","ImportDate","BenefitPackageId","IssuerId2","StateCode2","MarketCoverage","DentalOnlyPlan","TIN","StandardComponentId","PlanMarketingName","HIOSProductId","HPID","NetworkId","ServiceAreaId","FormularyId","IsNewPlan","PlanType","MetalLevel","UniquePlanDesign","QHPNonQHPTypeId","IsNoticeRequiredForPregnancy","IsReferralRequiredForSpecialist","SpecialistRequiringReferral","PlanLevelExclusions","IndianPlanVariationEstimatedAdvancedPaymentAmountPerEnrollee","IsHSAEligible","HSAOrHRAEmployerContribution","HSAOrHRAEmployerContributionAmount","ChildOnlyOffering","ChildOnlyPlanId","WellnessProgramOffered","DiseaseManagementProgramsOffered","EHBPediatricDentalApportionmentQuantity","EHBPercentPremiumS4","IsGuaranteedRate","SpecialtyDrugMaximumCoinsurance","InpatientCopaymentMaximumDays","BeginPrimaryCareCostSharingAfterNumberOfVisits","BeginPrimaryCareDeductibleCoinsuranceAfterNumberOfCopays","PlanEffictiveDate","PlanExpirationDate","OutOfCountryCoverage","OutOfCountryCoverageDescription","OutOfServiceAreaCoverage","OutOfServiceAreaCoverageDescription","NationalNetwork","URLForSummaryofBenefitsCoverage","URLForEnrollmentPayment","PlanBrochure","FormularyURL","PlanId","CSRVariationType","IssuerActuarialValue","AVCalculatorOutputNumber","MedicalDrugDeductiblesIntegrated","MedicalDrugMaximumOutofPocketIntegrated","MultipleInNetworkTiers","FirstTierUtilization","SecondTierUtilization","MEHBInnTier1IndividualMOOP","MEHBInnTier1FamilyMOOP","MEHBInnTier2IndividualMOOP","MEHBInnTier2FamilyMOOP","MEHBOutOfNetIndividualMOOP","MEHBOutOfNetFamilyMOOP","MEHBCombInnOonIndividualMOOP","MEHBCombInnOonFamilyMOOP","DEHBInnTier1IndividualMOOP","DEHBInnTier1FamilyMOOP","DEHBInnTier2IndividualMOOP","DEHBInnTier2FamilyMOOP","DEHBOutOfNetIndividualMOOP","DEHBOutOfNetFamilyMOOP","DEHBCombInnOonIndividualMOOP","DEHBCombInnOonFamilyMOOP","TEHBInnTier1IndividualMOOP","TEHBInnTier1FamilyMOOP","TEHBInnTier2IndividualMOOP","TEHBInnTier2FamilyMOOP","TEHBOutOfNetIndividualMOOP","TEHBOutOfNetFamilyMOOP","TEHBCombInnOonIndividualMOOP","TEHBCombInnOonFamilyMOOP","MEHBDedInnTier1Individual","MEHBDedInnTier1Family","MEHBDedInnTier1Coinsurance","MEHBDedInnTier2Individual","MEHBDedInnTier2Family","MEHBDedInnTier2Coinsurance","MEHBDedOutOfNetIndividual","MEHBDedOutOfNetFamily","MEHBDedCombInnOonIndividual","MEHBDedCombInnOonFamily","DEHBDedInnTier1Individual","DEHBDedInnTier1Family","DEHBDedInnTier1Coinsurance","DEHBDedInnTier2Individual","DEHBDedInnTier2Family","DEHBDedInnTier2Coinsurance","DEHBDedOutOfNetIndividual","DEHBDedOutOfNetFamily","DEHBDedCombInnOonIndividual","DEHBDedCombInnOonFamily","TEHBDedInnTier1Individual","TEHBDedInnTier1Family","TEHBDedInnTier1Coinsurance","TEHBDedInnTier2Individual","TEHBDedInnTier2Family","TEHBDedInnTier2Coinsurance","TEHBDedOutOfNetIndividual","TEHBDedOutOfNetFamily","TEHBDedCombInnOonIndividual","TEHBDedCombInnOonFamily","SBCHavingaBabyDeductible","SBCHavingaBabyCopayment","SBCHavingaBabyCoinsurance","SBCHavingaBabyLimit","SBCHavingDiabetesDeductible","SBCHavingDiabetesCopayment","SBCHavingDiabetesCoinsurance","SBCHavingDiabetesLimit","RowNumber"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0020002","Premier","21989AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/producers/grp/den.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/den.shtml",,"21989AK0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0020002","Premier","21989AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/producers/grp/den.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/den.shtml",,"21989AK0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0020001","Premier","21989AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/producers/grp/den.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/den.shtml",,"21989AK0020001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","Individual","Yes","93-0438772","21989AK0010001","Premier","21989AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/pdfs/plans/individual/ModaHealth_Premier_dental_AK_2014.pdf","https://www.modahealth.com/mymoda/","https://www.modahealth.com/pdfs/ak/members/2014/ind_health_plan_brochure.pdf",,"21989AK0010001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","Individual","Yes","93-0438772","21989AK0010001","Premier","21989AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/pdfs/plans/individual/ModaHealth_Premier_dental_AK_2014.pdf","https://www.modahealth.com/mymoda/","https://www.modahealth.com/pdfs/ak/members/2014/ind_health_plan_brochure.pdf",,"21989AK0010001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","21989","HIOS","6","2014-03-19 07:06:49","1","21989","AK","SHOP (Small Group)","Yes","93-0438772","21989AK0020001","Premier","21989AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,"OOP Max only applies to pediatric benefits",,,,,"Allows Adult and Child-Only",,,,"35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Network","Yes","https://www.modahealth.com/producers/grp/den.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/den.shtml",,"21989AK0020001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650002","Be Connected","73836AK065",,"AKN001","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650002-00","Standard Bronze Off Exchange Plan","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680004","PPO 1000A","73836AK068",,"AKN001","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680004-00","Standard Gold Off Exchange Plan",,"0.794966459274292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$470","$220","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680004","PPO 1000A","73836AK068",,"AKN001","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680004-01","Standard Gold On Exchange Plan",,"0.794966459274292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$470","$220","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650002","Be Connected","73836AK065",,"AKN001","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650002-01","Standard Bronze On Exchange Plan","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650002","Be Connected","73836AK065",,"AKN001","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630001","Be Protected","73836AK063",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630001-01","Standard Gold On Exchange Plan",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680038","Beneficial 2000","73836AK068",,"AKN002","AKS001","AKF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680038-00","Standard Silver Off Exchange Plan","68.98%","0.68980610370636","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630001","Be Protected","73836AK063",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","1","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0020001","Guardian Pediatric Essentials","42507AK002",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0020001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","1","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0020001","Guardian Pediatric Essentials","42507AK002",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0020001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","2","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0030001","Guardian Family Advantage Plus","42507AK003",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0030001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630001","Be Protected","73836AK063",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630001-03","Limited Cost Sharing Plan Variation",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680038","Beneficial 2000","73836AK068",,"AKN002","AKS001","AKF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680038-01","Standard Silver On Exchange Plan","68.98%","0.68980610370636","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-00","Standard Silver Off Exchange Plan",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-01","Standard Silver On Exchange Plan",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","AK","38536","HIOS","2","2013-08-01 12:48:00","1","38536","AK","SHOP (Small Group)","Yes","35-0472300","38536AK0010001","DentalConnect�","38536AK001",,"AKN001","AKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.31",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38536AK0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38536","HIOS","2","2013-08-01 12:48:00","1","38536","AK","SHOP (Small Group)","Yes","35-0472300","38536AK0010002","DentalConnect�","38536AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.83",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38536AK0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38536","HIOS","2","2013-08-01 12:48:00","2","38536","AK","SHOP (Small Group)","Yes","35-0472300","38536AK0010003","DentalConnect�","38536AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38536AK0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","1","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0010001","Guardian Pediatric Advantage","42507AK001",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0010001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","1","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0010001","Guardian Pediatric Advantage","42507AK001",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0010001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680034","Value 2000","73836AK068",,"AKN002","AKS001","AKF008","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680034-01","Standard Silver On Exchange Plan",,"0.695104360580444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","15"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680015","Beneficial 2000","73836AK068",,"AKN001","AKS001","AKF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680015-00","Standard Silver Off Exchange Plan","68.98%","0.68980610370636","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630001","Be Protected","73836AK063",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630001-00","Standard Gold Off Exchange Plan",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680015","Beneficial 2000","73836AK068",,"AKN001","AKS001","AKF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680015-01","Standard Silver On Exchange Plan","68.98%","0.68980610370636","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-03","Limited Cost Sharing Plan Variation",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-04","73% AV Level Silver Plan",,"0.737023711204529","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$5,000","Not Applicable","Not Applicable","$1,000","$20","$1,880","$150","$1,000","$850","$120","$80","12"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-05","87% AV Level Silver Plan",,"0.875849425792694","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$5,000","Not Applicable","Not Applicable","$500","$0","$750","$150","$500","$540","$210","$80","13"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630002","Be Prepared","73836AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630002-06","94% AV Level Silver Plan",,"0.93861997127533","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","30%",,,,"$200","$5,000","Not Applicable","Not Applicable","$100","$0","$400","$150","$100","$290","$110","$80","14"
"2014","AK","45858","HIOS","1","2013-06-04 08:25:28","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0030002","EHB High Passive","45858AK003",,"AKN001","AKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$76.12",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"45858AK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630003","Be Protected","73836AK063",,"AKN002","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630003-00","Standard Gold Off Exchange Plan",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","15"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-03","Limited Cost Sharing Plan Variation",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","22"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-04","73% AV Level Silver Plan",,"0.737023711204529","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$5,000","Not Applicable","Not Applicable","$1,000","$20","$1,880","$150","$1,000","$850","$120","$80","23"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-05","87% AV Level Silver Plan",,"0.875849425792694","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$5,000","Not Applicable","Not Applicable","$500","$0","$750","$150","$500","$540","$210","$80","24"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-06","94% AV Level Silver Plan",,"0.93861997127533","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","30%",,,,"$200","$5,000","Not Applicable","Not Applicable","$100","$0","$400","$150","$100","$290","$110","$80","25"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680017","Beneficial 4000","73836AK068",,"AKN001","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680017-00","Standard Bronze Off Exchange Plan","61.42%","0.614205181598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$1,640","$150","$4,000","$40","$540","$80","4"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","2","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0030001","Guardian Family Advantage Plus","42507AK003",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0030001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","3","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0050001","Guardian Family Essentials Plus","42507AK005",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0050001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","3","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0050001","Guardian Family Essentials Plus","42507AK005",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0050001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","4","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0040001","Guardian Family Advantage","42507AK004",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0040001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","4","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0040001","Guardian Family Advantage","42507AK004",,"AKN001","AKS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0040001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","4","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0060001","Guardian Family Essentials","42507AK006",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0060001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","42507","HIOS","3","2013-09-02 11:39:25","4","42507","AK","SHOP (Small Group)","Yes","13-5123390","42507AK0060001","Guardian Family Essentials","42507AK006",,"AKN001","AKS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42507AK0060001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","45858","HIOS","1","2013-06-04 08:25:28","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0040002","EHB High PPO","45858AK004",,"AKN001","AKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.00",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"45858AK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","45858","HIOS","1","2013-06-04 08:25:28","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0040001","EHB Low PPO","45858AK004",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.68",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"45858AK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-05","87% AV Level Silver Plan","87.55%","0.875486135482788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$0","$500","$150","$750","$350","$150","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680042","Beneficial 5000","73836AK068",,"AKN002","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680042-00","Standard Bronze Off Exchange Plan","60.45%","0.604491710662842","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$1,140","$150","$5,000","$0","$130","$80","10"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-06","94% AV Level Silver Plan","94.14%","0.941400468349457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","35%",,,,"$500","$1,000","Not Applicable","Not Applicable","$250","$0","$250","$150","$250","$220","$30","$80","10"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-00","Standard Silver Off Exchange Plan","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680042","Beneficial 5000","73836AK068",,"AKN002","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680042-01","Standard Bronze On Exchange Plan","60.45%","0.604491710662842","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$1,140","$150","$5,000","$0","$130","$80","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-01","Standard Silver On Exchange Plan","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","12"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-03","Limited Cost Sharing Plan Variation","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","14"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630003","Be Protected","73836AK063",,"AKN002","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630003-01","Standard Gold On Exchange Plan",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","16"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630003","Be Protected","73836AK063",,"AKN002","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630003","Be Protected","73836AK063",,"AKN002","AKS001","AKF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630003-03","Limited Cost Sharing Plan Variation",,"0.786747813224792","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$20","$980","$150","$750","$510","$160","$80","18"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-00","Standard Silver Off Exchange Plan",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","19"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","2","73836","AK","Individual","No","93-0989307","73836AK0630004","Be Prepared","73836AK063",,"AKN002","AKS001","AKF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995024875621891",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0630004-01","Standard Silver On Exchange Plan",,"0.7154421210289","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$20","$1,800","$150","$1,250","$670","$320","$80","20"
"2014","AK","45858","HIOS","1","2013-06-04 08:25:28","1","45858","AK","SHOP (Small Group)","Yes","47-0098400","45858AK0030001","EHB Low Passive","45858AK003",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$52.56",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"45858AK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680007","PPO 1500","73836AK068",,"AKN001","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680007-00","Standard Gold Off Exchange Plan",,"0.781277656555176","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,150","$150","$1,500","$410","$210","$80","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650002","Be Connected","73836AK065",,"AKN001","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650002-03","Limited Cost Sharing Plan Variation","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680007","PPO 1500","73836AK068",,"AKN001","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680007-01","Standard Gold On Exchange Plan",,"0.781277656555176","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,150","$150","$1,500","$410","$210","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650004","Be Connected","73836AK065",,"AKN002","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650004-00","Standard Bronze Off Exchange Plan","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680011","Value 2000","73836AK068",,"AKN001","AKS001","AKF008","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680011-00","Standard Silver Off Exchange Plan",,"0.695104360580444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680011","Value 2000","73836AK068",,"AKN001","AKS001","AKF008","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680011-01","Standard Silver On Exchange Plan",,"0.695104360580444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650004","Be Connected","73836AK065",,"AKN002","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650004-01","Standard Bronze On Exchange Plan","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650004","Be Connected","73836AK065",,"AKN002","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680027","PPO 1000A","73836AK068",,"AKN002","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680027-00","Standard Gold Off Exchange Plan",,"0.794966459274292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$470","$220","$80","10"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","Individual","No","93-0989307","73836AK0650004","Be Connected","73836AK065",,"AKN002","AKS001","AKF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650004-03","Limited Cost Sharing Plan Variation","61.92%","0.619164943695068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$4,500","$20","$970","$150","$4,500","$140","$60","$80","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680027","PPO 1000A","73836AK068",,"AKN002","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680027-01","Standard Gold On Exchange Plan",,"0.794966459274292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$470","$220","$80","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680030","PPO 1500","73836AK068",,"AKN002","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680030-00","Standard Gold Off Exchange Plan",,"0.781277656555176","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,150","$150","$1,500","$410","$210","$80","12"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680030","PPO 1500","73836AK068",,"AKN002","AKS001","AKF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680030-01","Standard Gold On Exchange Plan",,"0.781277656555176","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,150","$150","$1,500","$410","$210","$80","13"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","1","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680034","Value 2000","73836AK068",,"AKN002","AKS001","AKF008","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680034-00","Standard Silver Off Exchange Plan",,"0.695104360580444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,580","$150","$2,000","$610","$280","$80","14"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-00","Standard Silver Off Exchange Plan","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680017","Beneficial 4000","73836AK068",,"AKN001","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680017-01","Standard Bronze On Exchange Plan","61.42%","0.614205181598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$1,640","$150","$4,000","$40","$540","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-01","Standard Silver On Exchange Plan","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680019","Beneficial 5000","73836AK068",,"AKN001","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680019-00","Standard Bronze Off Exchange Plan","60.45%","0.604491710662842","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$1,140","$150","$5,000","$0","$130","$80","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-03","Limited Cost Sharing Plan Variation","68.95%","0.689477503299713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,500","$20","$1,430","$150","$2,500","$360","$230","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680019","Beneficial 5000","73836AK068",,"AKN001","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680019-01","Standard Bronze On Exchange Plan","60.45%","0.604491710662842","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$1,140","$150","$5,000","$0","$130","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650001","Be Aligned","73836AK065",,"AKN001","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650001-04","73% AV Level Silver Plan","72.46%","0.724550187587738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","35%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,730","$150","$1,500","$480","$310","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680040","Beneficial 4000","73836AK068",,"AKN002","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680040-00","Standard Bronze Off Exchange Plan","61.42%","0.614205181598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$1,640","$150","$4,000","$40","$540","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","SHOP (Small Group)","No","93-0989307","73836AK0680040","Beneficial 4000","73836AK068",,"AKN002","AKS001","AKF009","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/producers/grp/med.shtml","https://www.modahealth.com/employers/enroll.shtml","https://www.modahealth.com/producers/grp/med.shtml#tbd","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0680040-01","Standard Bronze On Exchange Plan","61.42%","0.614205181598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$1,640","$150","$4,000","$40","$540","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-04","73% AV Level Silver Plan","72.46%","0.724550187587738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","35%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$20","$1,730","$150","$1,500","$480","$310","$80","15"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-05","87% AV Level Silver Plan","87.55%","0.875486135482788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$750","$0","$500","$150","$750","$350","$150","$80","16"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","3","73836","AK","Individual","No","93-0989307","73836AK0650003","Be Aligned","73836AK065",,"AKN002","AKS001","AKF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0650003-06","94% AV Level Silver Plan","94.14%","0.941400468349457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","35%",,,,"$500","$1,000","Not Applicable","Not Applicable","$250","$0","$250","$150","$250","$220","$30","$80","17"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640001","Be Savvy","73836AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640001-00","Standard Bronze Off Exchange Plan",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","4"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640001","Be Savvy","73836AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640001-01","Standard Bronze On Exchange Plan",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","5"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640001","Be Savvy","73836AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640001","Be Savvy","73836AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640001-03","Limited Cost Sharing Plan Variation",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","7"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0620001","Be Bold","73836AK062",,"AKN001","AKS001","AKF004","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0620001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,470","$0","$0","$150","$1,270","$350","$0","$80","8"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640002","Be Savvy","73836AK064",,"AKN002","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640002-00","Standard Bronze Off Exchange Plan",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","9"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640002","Be Savvy","73836AK064",,"AKN002","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640002-01","Standard Bronze On Exchange Plan",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","10"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640002","Be Savvy","73836AK064",,"AKN002","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0640002","Be Savvy","73836AK064",,"AKN002","AKS001","AKF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0640002-03","Limited Cost Sharing Plan Variation",,"0.583061754703522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","40%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$5,250","$0","$810","$150","$5,250","$0","$10","$80","12"
"2014","AK","73836","HIOS","6","2014-04-18 11:49:29","4","73836","AK","Individual","No","93-0989307","73836AK0620002","Be Bold","73836AK062",,"AKN002","AKS001","AKF004","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Travel Network","Yes","Travel Network","Yes","https://www.modahealth.com/shop/explore-plans?a=42&fs=1&s=AK&ua=0&shop=m&he=False","https://www.modahealth.com/mymoda/","https://www.modahealth.com/producers/ind/121101/med.shtml","https://www.modahealth.com/medical/formularies.shtml?dn=ods","73836AK0620002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,470","$0","$0","$150","$1,270","$350","$0","$80","13"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","1","74819","AK","Individual","Yes","95-6042390","74819AK0020001","BESTOne Child Dental Plus","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Child_Dental_Plus_Plan.pdf",,"74819AK0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010001","BEST Life Child Dental Plus","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Child_Dental_Plus_Plan.pdf",,"74819AK0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","1","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010001","BEST Life Child Dental Plus","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Child_Dental_Plus_Plan.pdf",,"74819AK0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","1","74819","AK","Individual","Yes","95-6042390","74819AK0020001","BESTOne Child Dental Plus","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Child_Dental_Plus_Plan.pdf",,"74819AK0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","2","74819","AK","Individual","Yes","95-6042390","74819AK0020002","BESTOne Child Dental","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Child_Dental_Plan.pdf",,"74819AK0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010002","BEST Life Child Dental","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Child_Dental_Plan.pdf",,"74819AK0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","2","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010002","BEST Life Child Dental","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Child_Dental_Plan.pdf",,"74819AK0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","2","74819","AK","Individual","Yes","95-6042390","74819AK0020002","BESTOne Child Dental","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Child_Dental_Plan.pdf",,"74819AK0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010003","BEST Dental Advantage - Gold","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Advantage_Plan_(Gold).pdf",,"74819AK0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","Individual","Yes","95-6042390","74819AK0020003","BESTOne Dental Advantage - Gold","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"74819AK0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010003","BEST Dental Advantage - Gold","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Advantage_Plan_(Gold).pdf",,"74819AK0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","Individual","Yes","95-6042390","74819AK0020003","BESTOne Dental Advantage - Gold","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"74819AK0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","Individual","Yes","95-6042390","74819AK0020004","BESTOne Dental Plus - Gold","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"74819AK0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010004","BEST Dental Plus - Gold","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Plus_Plan_(Gold).pdf",,"74819AK0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010004","BEST Dental Plus - Gold","74819AK001",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Plus_Plan_(Gold).pdf",,"74819AK0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","3","74819","AK","Individual","Yes","95-6042390","74819AK0020004","BESTOne Dental Plus - Gold","74819AK002",,"AKN001","AKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"74819AK0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","Individual","Yes","95-6042390","74819AK0020005","BEST Dental Plus - Silver","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"74819AK0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010005","BEST Dental Plus - Silver","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Plus_Plan_(Silver).pdf",,"74819AK0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","Individual","Yes","95-6042390","74819AK0020005","BEST Dental Plus - Silver","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"74819AK0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010005","BEST Dental Plus - Silver","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Plus_Plan_(Silver).pdf",,"74819AK0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010006","BEST Dental Basic - Silver","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Basic_Plan_(Silver).pdf",,"74819AK0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","Individual","Yes","95-6042390","74819AK0020006","BEST Dental Basic - Silver","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"74819AK0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","Individual","Yes","95-6042390","74819AK0020006","BEST Dental Basic - Silver","74819AK002",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$55.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"74819AK0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","74819","HIOS","7","2014-01-21 08:29:49","4","74819","AK","SHOP (Small Group)","Yes","95-6042390","74819AK0010006","BEST Dental Basic - Silver","74819AK001",,"AKN001","AKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AK/pdf/AK_BEST_Dental_Basic_Plan_(Silver).pdf",,"74819AK0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AK","84859","HIOS","1","2013-06-06 10:50:48","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0040002","EHB High PPO","84859AK004",,"AKN001","AKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$61.00",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"84859AK0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Local Preferred Gold 2500/3500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360014-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","4","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0040001","Guardian Family Advantage","17454AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0040001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","4","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0040001","Guardian Family Advantage","17454AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0040001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","4","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0060001","Guardian Family Essentials","17454AZ006",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0060001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","4","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0060001","Guardian Family Essentials","17454AZ006",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0060001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","18156","HIOS","1","2013-06-06 10:50:48","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010001","DentalConnect�","18156AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"18156AZ0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","18156","HIOS","1","2013-06-06 10:50:48","1","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010002","DentalConnect�","18156AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.09",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"18156AZ0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","3","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0020002","Smile for Health Family C60A60","44785AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a60-ppo.pdf",,,,"44785AL0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","3","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0020002","Smile for Health Family C60A60","44785AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a60-ppo.pdf",,,,"44785AL0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","4","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0040001","Smile for Health Child C60A50","44785AL004",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a50-ppo.pdf",,,,"44785AL0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170002","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160004","Health Net PPO Gold $20/$40/$500","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","51485AZ0160004-00","Standard Gold Off Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170002","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170002-03","Limited Cost Sharing Plan Variation","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160004","Health Net PPO Gold $20/$40/$500","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","51485AZ0160004-01","Standard Gold On Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170003","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170003-00","Standard Platinum Off Exchange Plan","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160005","Health Net PPO Gold $20/$40/$1000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","51485AZ0160005-00","Standard Gold Off Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.26",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020001",,"77233AL0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","Individual","Yes","75-1233841","77233AL0010002","Dentegra Dental PPO Children's Plan 85","77233AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010002",,"77233AL0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020002",,"77233AL0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","Individual","Yes","75-1233841","77233AL0010002","Dentegra Dental PPO Children's Plan 85","77233AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010002",,"77233AL0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020002",,"77233AL0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","2","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020006","Dentegra Dental PPO Children's Plan 70  + Basic for adults for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.26",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020006",,"77233AL0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Local  Preferred Gold 2500/3500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360004-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Local  Preferred Gold 2500/3500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","4","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN004","AZS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$25.23",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069",,"17100AZ0190001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","4","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0190001","Family Enhanced Dental Plan (High)","17100AZ019",,"AZN004","AZS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$25.23",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49070",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49069",,"17100AZ0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0010001","Guardian Pediatric Advantage","17454AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0010001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0010001","Guardian Pediatric Advantage","17454AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0010001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020010","Delta Dental Preferred Pediatric - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$49.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020010-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010010","Delta Dental Preferred Pediatric - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$61.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010010-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020010","Delta Dental Preferred Pediatric - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$49.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020010-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","3","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031",,"ALN001","ALS001","ALF006","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueHSAGold?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueHSAGold?frm=Shop","https://www.bcbsal.org/BlueHSAGold?frm=Shop","46944AL0310001-01","Standard Gold On Exchange Plan",,"0.781932353973389","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$0","$580","$150","$1,500","$0","$350","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","3","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037",,"ALN001","ALS001","ALF005","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","46944AL0370001-03","Limited Cost Sharing Plan Variation","78.60%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200","20%","$600","$1,200","20%","$600","$1,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$600","$420","$0","$150","$20","$1,170","$0","$370","6"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","3","77233","AL","Individual","Yes","75-1233841","77233AL0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","77233AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010004",,"77233AL0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","3","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020004",,"77233AL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","3","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020004",,"77233AL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","3","77233","AL","Individual","Yes","75-1233841","77233AL0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","77233AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.66",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010004",,"77233AL0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.59",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020001",,"82285AL0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","Individual","Yes","94-2761537","82285AL0010001","Delta Dental PPO Plan 70 for Children","82285AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010001",,"82285AL0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.59",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020001",,"82285AL0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","Individual","Yes","94-2761537","82285AL0010001","Delta Dental PPO Plan 70 for Children","82285AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010001",,"82285AL0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","Individual","Yes","94-2761537","82285AL0010002","Delta Dental PPO Plan 85 for Children","82285AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010002",,"82285AL0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","2","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0030001","Guardian Family  Advantage Plus","17454AZ003",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0030001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0050001","Guardian Family Essentials Plus","17454AZ005",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0050001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","3","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0050001","Guardian Family Essentials Plus","17454AZ005",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0050001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0020001","Guardian Pediatric Essentials","17454AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0020001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","1","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0020001","Guardian Pediatric Essentials","17454AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0020001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","17454","HIOS","5","2013-09-17 16:07:07","2","17454","AZ","SHOP (Small Group)","Yes","13-5123390","17454AZ0030001","Guardian Family  Advantage Plus","17454AZ003",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"17454AZ0030001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Local Preferred Gold 2500/3500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360014-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Local Preferred Gold 2500/3500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-00","Standard Silver Off Exchange Plan","68.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$460","$1,160","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","15%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$710","$150","$460","$750","$0","$370","8"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020009","Delta Dental Basic Pediatric - PPO Plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$39.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020002","Delta Dental Preferred Pediatric - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020002-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010002","Delta Dental Preferred Pediatric - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$52.27",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010002-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020002","Delta Dental Preferred Pediatric - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020002-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","84859","HIOS","1","2013-06-06 10:50:48","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0040001","EHB Low PPO","84859AK004",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"84859AK0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","84859","HIOS","1","2013-06-06 10:50:48","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0030002","EHB High Passive","84859AK003",,"AKN001","AKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$77.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"84859AK0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AK","84859","HIOS","1","2013-06-06 10:50:48","1","84859","AK","SHOP (Small Group)","Yes","93-0242990","84859AK0030001","EHB Low Passive","84859AK003",,"AKN001","AKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.44",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"84859AK0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","1","12538","AL","Individual","Yes","95-6042390","12538AL0020001","BESTOne Child Dental Plus","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Child_Dental_Plus_Plan.pdf",,"12538AL0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010001","BEST Life Child Dental Plus","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Child_Dental_Plus_Plan.pdf",,"12538AL0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","1","12538","AL","Individual","Yes","95-6042390","12538AL0020001","BESTOne Child Dental Plus","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Child_Dental_Plus_Plan.pdf",,"12538AL0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","1","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010001","BEST Life Child Dental Plus","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Child_Dental_Plus_Plan.pdf",,"12538AL0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","2","12538","AL","Individual","Yes","95-6042390","12538AL0020002","BESTOne Child Dental","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Child_Dental_Plan.pdf",,"12538AL0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010002","BEST Life Child Dental","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Child_Denta_Plan.pdf",,"12538AL0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","2","12538","AL","Individual","Yes","95-6042390","12538AL0020002","BESTOne Child Dental","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Child_Dental_Plan.pdf",,"12538AL0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","2","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010002","BEST Life Child Dental","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Child_Denta_Plan.pdf",,"12538AL0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010003","BEST Dental Advantage - Gold","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Advantage_Plan_(Gold).pdf",,"12538AL0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","Individual","Yes","95-6042390","12538AL0020003","BESTOne Dental Advantage - Gold","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"12538AL0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","Individual","Yes","95-6042390","12538AL0020003","BESTOne Dental Advantage - Gold","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"12538AL0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010003","BEST Dental Advantage - Gold","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Advantage_Plan_(Gold).pdf",,"12538AL0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010004","BEST Dental Plus - Gold","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Plus_Plan_(Gold).pdf",,"12538AL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","Individual","Yes","95-6042390","12538AL0020004","BESTOne Dental Plus - Gold","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"12538AL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010004","BEST Dental Plus - Gold","12538AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$86.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Plus_Plan_(Gold).pdf",,"12538AL0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","3","12538","AL","Individual","Yes","95-6042390","12538AL0020004","BESTOne Dental Plus - Gold","12538AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"12538AL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010005","BEST Dental Plus - Silver","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Plus_Plan_(Silver).pdf",,"12538AL0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","Individual","Yes","95-6042390","12538AL0020005","BESTOne Dental Plus - Silver","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"12538AL0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010005","BEST Dental Plus - Silver","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Plus_Plan_(Silver).pdf",,"12538AL0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","Individual","Yes","95-6042390","12538AL0020005","BESTOne Dental Plus - Silver","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"12538AL0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","Individual","Yes","95-6042390","12538AL0020006","BESTOne Dental Basic - Silver","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"12538AL0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010006","BEST Dental Basic - Silver","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Basic_Plan_(Silver).pdf",,"12538AL0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","Individual","Yes","95-6042390","12538AL0020006","BESTOne Dental Basic - Silver","12538AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"12538AL0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","12538","HIOS","8","2014-01-21 08:29:49","4","12538","AL","SHOP (Small Group)","Yes","95-6042390","12538AL0010006","BEST Dental Basic - Silver","12538AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.76",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AL/pdf/AL_BEST_Dental_Basic_Plan_(Silver).pdf",,"12538AL0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0010001","Guardian Pediatric Advantage","17540AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0010001","Guardian Pediatric Advantage","17540AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0010001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0020001","Guardian Pediatric Essentials","17540AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0020001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","1","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0020001","Guardian Pediatric Essentials","17540AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0020001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0030001","Guardian Family Advantage Plus","17540AL003",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0030001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","2","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0030001","Guardian Family Advantage Plus","17540AL003",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0030001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","3","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0050001","Guardian Family Essentials Plus","17540AL005",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0050001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","3","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0050001","Guardian Family Essentials Plus","17540AL005",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0050001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","4","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0040001","Guardian Family Advantage","17540AL004",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0040001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","4","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0040001","Guardian Family Advantage","17540AL004",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0040001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","4","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0060001","Guardian Family Essentials","17540AL006",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0060001-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","17540","HIOS","3","2013-09-02 11:39:25","4","17540","AL","SHOP (Small Group)","Yes","13-5123390","17540AL0060001","Guardian Family Essentials","17540AL006",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"17540AL0060001-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","Yes","39-1263473","44580AL0380001","Humana Dental Smart Choice","44580AL038",,"ALN003","ALS003",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"44580AL0380001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360003","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN001","ALS001","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","Individual","No","63-0103830","46944AL0360001","Blue Access Gold","46944AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","46944AL0360001-01","Standard Gold On Exchange Plan","78.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%","$500","$1,000","20%","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$420","$0","$150","$20","$1,220","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","Individual","No","63-0103830","46944AL0360001","Blue Access Gold","46944AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","46944AL0360001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$20","$0","$0","$370","6"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Local  Preferred Gold 2500/3500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360004","Humana Local  Preferred Gold 2500/3500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360005-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360005","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN001","ALS001","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360013","Humana Local Preferred Silver 4600/6300 Plan","44580AL036",,"ALN002","ALS002","ALF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103478","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057185","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360013-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043",,"ALN001","ALS001","ALF010","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","46944AL0430001-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400","40%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$4,200","$20","$1,220","$150","$1,560","$920","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$460","$1,160","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$370","6"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$460","$1,160","$0","$370","7"
"2014","AZ","18156","HIOS","1","2013-06-06 10:50:48","2","18156","AZ","SHOP (Small Group)","Yes","35-0472300","18156AZ0010003","DentalConnect�","18156AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"18156AZ0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010001","Delta Dental Basic Pediatric - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$42.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020001","Delta Dental Basic Pediatric - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$32.97",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010001","Delta Dental Basic Pediatric - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$42.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010009","Delta Dental Basic Pediatric - PPO Plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$49.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160005","Health Net PPO Gold $20/$40/$1000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","51485AZ0160005-01","Standard Gold On Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170003","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360014","Humana Local Preferred Gold 2500/3500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103491","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057094","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360014-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360015-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360015-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","1","44580","AL","Individual","No","39-1263473","44580AL0360015","Humana Local Preferred Platinum 1000/1500 Plan","44580AL036",,"ALN002","ALS002","ALF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103504","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057120","http://apps.humana.com/marketing/documents.asp?file=2067403","44580AL0360015-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360001","Humana Local Preferred Basic 6350/6350 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103413","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057068","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360001","Humana Local Preferred Basic 6350/6350 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103413","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057068","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360002","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN001","ALS001","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360011","Humana Local Preferred Basic 6350/6350 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103413","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057068","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360011","Humana Local Preferred Basic 6350/6350 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103413","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057068","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360012-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360012-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","AL","44580","HIOS","10","2014-01-21 08:29:49","2","44580","AL","Individual","No","39-1263473","44580AL0360012","Humana Local Preferred Bronze 6300/6300 Plan","44580AL036",,"ALN002","ALS002","ALF001","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99899",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2103465","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057146","http://apps.humana.com/marketing/documents.asp?file=2067338","44580AL0360012-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","1","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0010002","Smile for Health Family C60A70","44785AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a70-ppo.pdf",,,,"44785AL0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","1","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0010002","Smile for Health Family C60A70","44785AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a70-ppo.pdf",,,,"44785AL0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","1","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0010001","Smile for Health Child C60A70","44785AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a70-ppo.pdf",,,,"44785AL0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","1","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0010001","Smile for Health Child C60A70","44785AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a70-ppo.pdf",,,,"44785AL0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","2","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0090001","Smile for Health Child C60","44785AL009",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,,,,"44785AL0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","3","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0020001","Smile for Health Child C60A60","44785AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a60-ppo.pdf",,,,"44785AL0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","3","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0020001","Smile for Health Child C60A60","44785AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a60-ppo.pdf",,,,"44785AL0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","4","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0040001","Smile for Health Child C60A50","44785AL004",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c60a50-ppo.pdf",,,,"44785AL0040001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","4","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0040002","Smile For Family C60A50","44785AL004",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a50-ppo.pdf",,,,"44785AL0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","4","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0040002","Smile For Family C60A50","44785AL004",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c60a50-ppo.pdf",,,,"44785AL0040002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","5","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0100001","Smile for Health Child C80","44785AL010",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0100001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","6","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0070001","Smile for Health Child C80A80","44785AL007",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c80a80-ppo.pdf",,,,"44785AL0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","6","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0070001","Smile for Health Child C80A80","44785AL007",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-child-c80a80-ppo.pdf",,,,"44785AL0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","6","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0070002","Smile for Health Family C80A80","44785AL007",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c80a80-ppo.pdf",,,,"44785AL0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","6","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0070002","Smile for Health Family C80A80","44785AL007",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-al-grp-family-c80a80-ppo.pdf",,,,"44785AL0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","7","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0030001","Smile for Health Child C60A80","44785AL003",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0030001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","7","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0030002","Smile for Health Family C60A80","44785AL003",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0030002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","8","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0080001","Smile for Health Child C80A50","44785AL008",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0080001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","8","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0080002","Smile for Health Family C80A50","44785AL008",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0080002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","9","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0060001","Smile for Health Child C80A60","44785AL006",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0060001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","9","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0060002","Smile for Health Family C80A60","44785AL006",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0060002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","10","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0050001","Smile for Health Child C80A70","44785AL005",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0050001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","44785","HIOS","4","2013-09-10 14:43:20","10","44785","AL","SHOP (Small Group)","Yes","63-1028262","44785AL0050002","Smile for Health Family C80A70","44785AL005",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$28.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"44785AL0050002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","46211","HIOS","1","2013-06-06 10:50:48","1","46211","AL","SHOP (Small Group)","Yes","35-0472300","46211AL0010001","DentalConnect�","46211AL001",,"ALN001","ALS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"46211AL0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","46211","HIOS","1","2013-06-06 10:50:48","1","46211","AL","SHOP (Small Group)","Yes","35-0472300","46211AL0010002","DentalConnect�","46211AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"46211AL0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","46211","HIOS","1","2013-06-06 10:50:48","2","46211","AL","SHOP (Small Group)","Yes","35-0472300","46211AL0010003","DentalConnect�","46211AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"46211AL0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","Individual","No","63-0103830","46944AL0300001","Blue Choice Platinum","46944AL030",,"ALN001","ALS001","ALF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","46944AL0300001-00","Standard Platinum Off Exchange Plan","88.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"$100","$200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$320","$0","$150","$20","$810","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","Individual","Yes","63-0103830","46944AL0500001","Dental Blue Plus","46944AL050",,"ALN001","ALS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.00","0","Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","No",,"https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/DentalBluePlus?frm=Exchange",,"46944AL0500001-01","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","SHOP (Small Group)","Yes","63-0103830","46944AL0530001","Dental Blue Plus for Business","46944AL053",,"ALN001","ALS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefits are paid toward the lesser of the allowed amount or the dentist's actual charge for the service.","Yes",,"https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/DentalBluePlusForBusiness?frm=Shop",,"46944AL0530001-01","Standard Low On Exchange Plan","69.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028",,"ALN001","ALS001","ALF002","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","46944AL0280001-00","Standard Platinum Off Exchange Plan","88.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"$100","$200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$320","$0","$150","$20","$810","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0280001","Blue Choice Platinum for Business","46944AL028",,"ALN001","ALS001","ALF002","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","https://www.bcbsal.org/BlueChoicePlatinum?frm=Shop","46944AL0280001-01","Standard Platinum On Exchange Plan","88.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"$100","$200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$320","$0","$150","$20","$810","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","Individual","No","63-0103830","46944AL0300001","Blue Choice Platinum","46944AL030",,"ALN001","ALS001","ALF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","46944AL0300001-01","Standard Platinum On Exchange Plan","88.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"$100","$200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$320","$0","$150","$20","$810","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","Individual","No","63-0103830","46944AL0300001","Blue Choice Platinum","46944AL030",,"ALN001","ALS001","ALF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","46944AL0300001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$20","$0","$0","$370","6"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","1","46944","AL","Individual","No","63-0103830","46944AL0300001","Blue Choice Platinum","46944AL030",,"ALN001","ALS001","ALF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998",,,"5","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","https://www.ibcbsal.com/BlueChoicePlatinum?frm=Exchange","46944AL0300001-03","Limited Cost Sharing Plan Variation","88.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"$100","$200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$320","$0","$150","$20","$810","$0","$370","7"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034",,"ALN001","ALS001","ALF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueAccessGold?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueAccessGold?frm=Shop","https://www.bcbsal.org/BlueAccessGold?frm=Shop","46944AL0340001-00","Standard Gold Off Exchange Plan","78.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%","$500","$1,000","20%","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$420","$0","$150","$20","$1,220","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","Individual","No","63-0103830","46944AL0360001","Blue Access Gold","46944AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","46944AL0360001-00","Standard Gold Off Exchange Plan","78.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%","$500","$1,000","20%","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$420","$0","$150","$20","$1,220","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0340001","Blue Access Gold for Business","46944AL034",,"ALN001","ALS001","ALF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueAccessGold?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueAccessGold?frm=Shop","https://www.bcbsal.org/BlueAccessGold?frm=Shop","46944AL0340001-01","Standard Gold On Exchange Plan","78.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%","$500","$1,000","20%","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$420","$0","$150","$20","$1,220","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","2","46944","AL","Individual","No","63-0103830","46944AL0360001","Blue Access Gold","46944AL036",,"ALN001","ALS001","ALF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","https://www.ibcbsal.com/BlueAccessGold?frm=Exchange","46944AL0360001-03","Limited Cost Sharing Plan Variation","78.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%","$500","$1,000","20%","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$420","$0","$150","$20","$1,220","$0","$370","7"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","3","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037",,"ALN001","ALS001","ALF005","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","46944AL0370001-01","Standard Gold On Exchange Plan","78.60%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200","20%","$600","$1,200","20%","$600","$1,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$600","$420","$0","$150","$20","$1,170","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","3","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0310001","Blue HSA Gold for Business","46944AL031",,"ALN001","ALS001","ALF006","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueHSAGold?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueHSAGold?frm=Shop","https://www.bcbsal.org/BlueHSAGold?frm=Shop","46944AL0310001-00","Standard Gold Off Exchange Plan",,"0.781932353973389","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$0","$580","$150","$1,500","$0","$350","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","3","46944","AL","Individual","No","63-0103830","46944AL0370001","Blue Value Gold","46944AL037",,"ALN001","ALS001","ALF005","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","https://www.ibcbsal.com/BlueValueGold?frm=Exchange","46944AL0370001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$20","$0","$0","$370","5"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","3","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN003","AZS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067",,"17100AZ0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","3","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0180001","Family Basic Dental Plan (Low)","17100AZ018",,"AZN003","AZS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49068",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49067",,"17100AZ0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010003","Delta Dental Basic Pediatric and Family - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$42.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020009","Delta Dental Basic Pediatric - PPO Plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$39.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020009-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","Individual","Yes","86-0274899","30045AZ0010009","Delta Dental Basic Pediatric - PPO Plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$49.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010009-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160006","Health Net PPO Gold $20/$40/$2000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","51485AZ0160006-00","Standard Gold Off Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","2","82285","AL","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","82285AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010006",,"82285AL0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","2","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.59",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020006",,"82285AL0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","3","82285","AL","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Plan 85 for Children + Preferred for adults","82285AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010004",,"82285AL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","3","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020004","Delta Dental PPO Plan 85 for Children + Preferred for adults for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020004",,"82285AL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","3","82285","AL","Individual","Yes","94-2761537","82285AL0010004","Delta Dental PPO Plan 85 for Children + Preferred for adults","82285AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010004",,"82285AL0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","3","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020004","Delta Dental PPO Plan 85 for Children + Preferred for adults for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020004",,"82285AL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","1","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0160001","EHB Basic Dental Plan (Low)","17100AZ016",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48029",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48028",,"17100AZ0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","1","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0160001","EHB Basic Dental Plan (Low)","17100AZ016",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48029",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48028",,"17100AZ0160001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","2","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0170001","EHB Enhanced Dental Plan (High)","17100AZ017",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$25.23",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49066",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49065",,"17100AZ0170001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","17100","HIOS","7","2013-10-15 07:27:56","2","17100","AZ","SHOP (Small Group)","Yes","13-5581829","17100AZ0170001","EHB Enhanced Dental Plan (High)","17100AZ017",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$25.23",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49066",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49065",,"17100AZ0170001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020003","Delta Dental Basic Pediatric and Family - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$32.97",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020003","Delta Dental Basic Pediatric and Family - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$32.97",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-00","Standard Silver Off Exchange Plan","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-01","Standard Silver On Exchange Plan","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160006","Health Net PPO Gold $20/$40/$2000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","51485AZ0160006-01","Standard Gold On Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170005","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170005-01","Standard Gold On Exchange Plan","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170005","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038",,"ALN001","ALS001","ALF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","46944AL0380001-00","Standard Silver Off Exchange Plan","69.00%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%","$2,000","$4,000","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$620","$0","$150","$20","$1,640","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-00","Standard Silver Off Exchange Plan","68.60%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","20%","$2,400","$4,800","20%","$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$620","$0","$150","$20","$1,630","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0380001","Blue Secure Silver for Business","46944AL038",,"ALN001","ALS001","ALF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","https://www.bcbsal.org/BlueSecureSilver?frm=Shop","46944AL0380001-01","Standard Silver On Exchange Plan","69.00%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%","$2,000","$4,000","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$620","$0","$150","$20","$1,640","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-01","Standard Silver On Exchange Plan","68.60%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","20%","$2,400","$4,800","20%","$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$620","$0","$150","$20","$1,630","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$370","6"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-03","Limited Cost Sharing Plan Variation","68.60%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","20%","$2,400","$4,800","20%","$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$620","$0","$150","$20","$1,630","$0","$370","7"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-04","73% AV Level Silver Plan","73.80%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%","$1,750","$3,500","20%","$1,750","$3,500","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$620","$0","$150","$20","$1,630","$0","$370","8"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-05","87% AV Level Silver Plan","87.50%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%","$400","$800","20%","$400","$800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$600","$0","$150","$20","$980","$0","$370","9"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","4","46944","AL","Individual","No","63-0103830","46944AL0410001","Blue Value Silver","46944AL041",,"ALN001","ALS001","ALF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","https://www.ibcbsal.com/BlueValueSilver?frm=Exchange","46944AL0410001-06","94% AV Level Silver Plan","93.70%",,"No","Yes","Yes","95%","5%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%","$100","$200","10%","$100","$200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$160","$0","$150","$20","$430","$0","$370","10"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","SHOP (Small Group)","No","63-0103830","46944AL0430001","Blue Saver Bronze for Business","46944AL043",,"ALN001","ALS001","ALF010","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If a PPO provider is used same benefits as PPO in country. If non-PPO provider is used member is responsible for filing claims and out of network benefits would be applicable.","Yes","If a PPO provider is used same benefits as PPO in service area. If non-PPO provider is used member may be responsible for filing claims and out of network benefits would be applicable.","Yes","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","https://sso.bcbsal.org/sp/ACS.saml2","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","https://www.bcbsal.org/BlueSaverBronze?frm=Shop","46944AL0430001-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,200","$8,400","40%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$4,200","$20","$1,220","$150","$1,560","$920","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-05","87% AV Level Silver Plan","87.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$680","$150","$460","$630","$0","$370","9"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","5","46944","AL","Individual","No","63-0103830","46944AL0420001","Blue Saver Silver","46944AL042",,"ALN001","ALS001","ALF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","https://www.ibcbsal.com/BlueSaverSilver?frm=Exchange","46944AL0420001-06","94% AV Level Silver Plan","95.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","5%",,,,"$100","$200","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$20","$360","$150","$100","$350","$20","$370","10"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","6","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046",,"ALN001","ALS001","ALF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","46944AL0460001-00","Standard Bronze Off Exchange Plan","60.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$1,560","$920","$0","$370","4"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","6","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046",,"ALN001","ALS001","ALF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","46944AL0460001-01","Standard Bronze On Exchange Plan","60.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$1,560","$920","$0","$370","5"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","6","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046",,"ALN001","ALS001","ALF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","46944AL0460001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$370","6"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","6","46944","AL","Individual","No","63-0103830","46944AL0460001","Blue Saver Bronze","46944AL046",,"ALN001","ALS001","ALF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","https://www.ibcbsal.com/BlueSaverBronze?frm=Exchange","46944AL0460001-03","Limited Cost Sharing Plan Variation","60.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$1,560","$920","$0","$370","7"
"2014","AL","46944","HIOS","7","2014-01-17 09:36:20","7","46944","AL","Individual","No","63-0103830","46944AL0470001","Blue Protect","46944AL047",,"ALN001","ALS001","ALF012","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","If PPO provider is used, same benefits as PPO in country apply. If non PPO provider is used, member is responsible for filing claims and out-of-network benefits would be applicable.","Yes","If PPO provider is used, same benefits as PPO in service area apply. If non PPO provider is used, member may be responsible for filing claims and out-of-network benefits would be applicable.","Yes","https://www.ibcbsal.com/BlueProtect?frm=Exchange","https://sso.bcbsal.org/sp/ACS.saml2","https://www.ibcbsal.com/BlueProtect?frm=Exchange","https://www.ibcbsal.com/BlueProtect?frm=Exchange","46944AL0470001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$4,670","$150","$0","$370","4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","1","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080010","UnitedHealthcare Gold HSA (UG-9 with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Gold","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080010-01","Standard Gold On Exchange Plan","78.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","1","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080011","UnitedHealthcare Silver HSA (U4-L with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080011-01","Standard Silver On Exchange Plan","69.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","1","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080012","UnitedHealthcare Bronze HSA (U4-M with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080012-01","Standard Bronze On Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","2","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080001","UnitedHealthcare Platinum Traditional (U3-5 with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080001-01","Standard Platinum On Exchange Plan","88.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","2","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080002","UnitedHealthcare Platinum Traditional (U3-5 with B3)","59809AL008",,"ALN002","ALS001","ALF002","New","POS","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080002-01","Standard Platinum On Exchange Plan","88.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","3","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080006","UnitedHealthcare Silver Balanced (U3-8 with B6)","59809AL008",,"ALN002","ALS001","ALF004","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080006-01","Standard Silver On Exchange Plan","70.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","4","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080005","UnitedHealthcare Silver Balanced (U3-7 with B6)","59809AL008",,"ALN002","ALS001","ALF004","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080005-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","5","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080007","UnitedHealthcare Silver Consumer (U3-9 with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080007-01","Standard Silver On Exchange Plan","69.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","5","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080008","UnitedHealthcare Bronze Consumer (UG-7 with A8)","59809AL008",,"ALN002","ALS001","ALF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080008-01","Standard Bronze On Exchange Plan","60.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","5","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080009","UnitedHealthcare Bronze Consumer (UG-8 with B3)","59809AL008",,"ALN002","ALS001","ALF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080009-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","6","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080003","UnitedHealthcare Gold Traditional (U3-6 with B4)","59809AL008",,"ALN002","ALS001","ALF003","New","POS","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080003-01","Standard Gold On Exchange Plan","80.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AL","59809","HIOS","8","2014-01-16 07:24:04","6","59809","AL","SHOP (Small Group)","No","86-0207231","59809AL0080004","UnitedHealthcare Gold Traditional (U3-6 with B6)","59809AL008",,"ALN002","ALS001","ALF004","New","POS","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"0",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopAL",,"www.welcometouhc.com/shopAL","www.myuhc.com","59809AL0080004-01","Standard Gold On Exchange Plan","78.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.26",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020001",,"77233AL0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","Individual","Yes","75-1233841","77233AL0010001","Dentegra Dental PPO Children's Plan 70","77233AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010001",,"77233AL0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","1","77233","AL","Individual","Yes","75-1233841","77233AL0010001","Dentegra Dental PPO Children's Plan 70","77233AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010001",,"77233AL0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","2","77233","AL","Individual","Yes","75-1233841","77233AL0010006","Dentegra Dental PPO Children's Plan 70  + Basic for adults","77233AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010006",,"77233AL0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","2","77233","AL","SHOP (Small Group)","Yes","75-1233841","77233AL0020006","Dentegra Dental PPO Children's Plan 70  + Basic for adults for Small Businesses","77233AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.26",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0020006",,"77233AL0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","77233","HIOS","6","2014-01-17 09:36:20","2","77233","AL","Individual","Yes","75-1233841","77233AL0010006","Dentegra Dental PPO Children's Plan 70  + Basic for adults","77233AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/al/77233al0010006",,"77233AL0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020002",,"82285AL0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","Individual","Yes","94-2761537","82285AL0010002","Delta Dental PPO Plan 85 for Children","82285AL001",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010002",,"82285AL0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","1","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020002",,"82285AL0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","$15","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","2","82285","AL","Individual","Yes","94-2761537","82285AL0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","82285AL001",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0010006",,"82285AL0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AL","82285","HIOS","7","2014-01-21 08:29:49","2","82285","AL","SHOP (Small Group)","Yes","94-2761537","82285AL0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","82285AL002",,"ALN001","ALS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.59",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/al/82285al0020006",,"82285AL0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160015","Health Net PPO Platinum $15/$30/$500","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","51485AZ0160015-01","Standard Platinum On Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-04","73% AV Level Silver Plan","73.90%","0.727959990501404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170009","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170009-00","Standard Platinum Off Exchange Plan","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170009","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170009-01","Standard Platinum On Exchange Plan","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010003","Delta Dental Basic Pediatric and Family - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$42.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010003-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010011","Delta Dental Basic Pediatric and Family - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$49.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170006","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170006-03","Limited Cost Sharing Plan Variation","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160014","Health Net PPO Platinum $15/$30/$350","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160014-00","Standard Platinum Off Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170009","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170009","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170009-03","Limited Cost Sharing Plan Variation","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170010","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170010-00","Standard Gold Off Exchange Plan","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170010","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170010-01","Standard Gold On Exchange Plan","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170008","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170008-03","Limited Cost Sharing Plan Variation","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160010","Health Net PPO Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_shop.pdf","www.healthnet.com/drugs","51485AZ0160010-01","Standard Silver On Exchange Plan","68.10%","0.681479394435883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400003","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400004-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400004","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400005-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400005","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$9,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400013","Humana Connect Silver 4600/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103543","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057341","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400013-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400014-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400014-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400014","Humana Connect Gold 2500/3500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103556","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057276","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400014-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400015-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400015-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","1","23307","AZ","Individual","No","61-1013183","23307AZ0400015","Humana Connect Platinum 1000/1500 Plan","23307AZ040",,"AZN002","AZS002","AZF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103569","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057315","http://apps.humana.com/marketing/documents.asp?file=2067403","23307AZ0400015-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400001","Humana Connect Basic 6350/6350 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103517","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057263","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400001","Humana Connect Basic 6350/6350 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103517","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057263","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400002","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400011","Humana Connect Basic 6350/6350 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103517","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057263","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400011","Humana Connect Basic 6350/6350 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103517","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057263","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400012-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400012-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","AZ","23307","HIOS","8","2014-01-16 07:24:04","2","23307","AZ","Individual","No","61-1013183","23307AZ0400012","Humana Connect Bronze 6300/6300 Plan","23307AZ040",,"AZN002","AZS002","AZF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103530","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057224","http://apps.humana.com/marketing/documents.asp?file=2067338","23307AZ0400012-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","1","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020001","Delta Dental Basic Pediatric - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$32.97",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010002","Delta Dental Preferred Pediatric - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$52.27",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010002-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","2","30045","AZ","Individual","Yes","86-0274899","30045AZ0010010","Delta Dental Preferred Pediatric - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"Coverage not available for anyone over age 18. For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Child-Only",,,,"$61.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010010-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160014","Health Net PPO Platinum $15/$30/$350","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160014-01","Standard Platinum On Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160015","Health Net PPO Platinum $15/$30/$500","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","51485AZ0160015-00","Standard Platinum Off Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-03","Limited Cost Sharing Plan Variation","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160012","Health Net HSA Silver 20%/20%/$2000/$6350","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160012-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160013","Health Net HSA Silver 20%/20%/$2000/$5000","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160013-00","Standard Silver Off Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160013","Health Net HSA Silver 20%/20%/$2000/$5000","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160013-01","Standard Silver On Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160028","Health Net Bronze 50%/50%$5500","51485AZ016",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160028-00","Standard Bronze Off Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$24,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160028","Health Net Bronze 50%/50%$5500","51485AZ016",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160028-01","Standard Bronze On Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$24,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160024","Health Net HSA Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","51485AZ0160024-00","Standard Silver Off Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160024","Health Net HSA Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","51485AZ0160024-01","Standard Silver On Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160025","Health Net HSA Silver 20%/20%/$2000/$6350","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160025-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170011","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170011-00","Standard Gold Off Exchange Plan","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170011","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170011-01","Standard Gold On Exchange Plan","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170003","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170003-03","Limited Cost Sharing Plan Variation","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170004","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170004-00","Standard Gold Off Exchange Plan","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170004","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170004-01","Standard Gold On Exchange Plan","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170004","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170004","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170004-03","Limited Cost Sharing Plan Variation","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170005","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170005-00","Standard Gold Off Exchange Plan","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020011","Delta Dental Basic Pediatric and Family - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$39.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020011-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","Individual","Yes","86-0274899","30045AZ0010011","Delta Dental Basic Pediatric and Family - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$49.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","3","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020011","Delta Dental Basic Pediatric and Family - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","Low",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$39.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020011-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","Individual","Yes","86-0274899","30045AZ0010004","Delta Dental Preferred Pediatric and Family - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$52.27",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010004-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020004","Delta Dental Preferred Pediatric and Family - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020004-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","Individual","Yes","86-0274899","30045AZ0010004","Delta Dental Preferred Pediatric and Family - PPO","30045AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$52.27",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020004","Delta Dental Preferred Pediatric and Family - PPO","30045AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020004-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","Individual","Yes","86-0274899","30045AZ0010012","Delta Dental Preferred Pediatric and Family - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$61.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010012-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020012","Delta Dental Preferred Pediatric and Family - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$49.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020012-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","Individual","Yes","86-0274899","30045AZ0010012","Delta Dental Preferred Pediatric and Family - PPO plus Premier","30045AZ001",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$61.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalcoversme.com/plan-options/az-plans","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalcoversme.com/plan-options/az-plans",,"30045AZ0010012-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","30045","HIOS","5","2014-03-19 07:06:49","4","30045","AZ","SHOP (Small Group)","Yes","86-0274899","30045AZ0020012","Delta Dental Preferred Pediatric and Family - PPO plus Premier","30045AZ002",,"AZN002","AZS001",,"New","PPO","High",,"Both",,,,"For a full list of exclusions please see Summary of Benefits & Coverage.",,,,,"Allows Adult and Child-Only",,,,"$49.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","In a foreign country and need dental treatment? No worries, Delta Dental covers you wherever you go.","Yes","Traveling out of state and need dental treatment? Delta Dental is there to cover you with America’s largest network of dentists.","Yes","www.deltadentalaz.com/sbc","https://auth.deltadentalaz.com/sp/ACS.saml2","www.deltadentalaz.com/sbc",,"30045AZ0020012-01","Standard High On Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","1","33851","AZ","Individual","Yes","91-1857813","33851AZ0110001","Smile for Kids (EHB)","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","1","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120001","Smile for Kids (EHB)","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120001-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","1","33851","AZ","Individual","Yes","91-1857813","33851AZ0110001","Smile for Kids (EHB)","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","1","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120001","Smile for Kids (EHB)","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","Individual","Yes","91-1857813","33851AZ0110002","PPO Family with EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110002-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120002","PPO Family with EHB","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120002-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120002","PPO Family with EHB","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120002-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","Individual","Yes","91-1857813","33851AZ0110002","PPO Family with EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110002-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120003","PLUS Family with EHB","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120003-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","Individual","Yes","91-1857813","33851AZ0110003","PLUS Family with EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110003-00","Standard Low Off Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","Individual","Yes","91-1857813","33851AZ0110003","PLUS Family with EHB","33851AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$27.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0110003-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","33851","HIOS","5","2013-09-16 06:33:22","2","33851","AZ","SHOP (Small Group)","Yes","91-1857813","33851AZ0120003","PLUS Family with EHB","33851AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/azhealthreform",,"www.premierlife.com/azhealthreform",,"33851AZ0120003-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170001","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170001-00","Standard Platinum Off Exchange Plan","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160001","Health Net PPO Platinum $15/$30/$350","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160001-00","Standard Platinum Off Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160001","Health Net PPO Platinum $15/$30/$350","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160001-01","Standard Platinum On Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170001","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170001-01","Standard Platinum On Exchange Plan","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170001","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160002","Health Net PPO Platinum $15/$30/$500","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_ped_ sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","51485AZ0160002-00","Standard Platinum Off Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170001","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170001-03","Limited Cost Sharing Plan Variation","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160002","Health Net PPO Platinum $15/$30/$500","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_ped_ sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","51485AZ0160002-01","Standard Platinum On Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170002","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170002-00","Standard Platinum Off Exchange Plan","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160003","Health Net PPO Platinum $15/$30/$750","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","51485AZ0160003-00","Standard Platinum Off Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160003","Health Net PPO Platinum $15/$30/$750","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","51485AZ0160003-01","Standard Platinum On Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170002","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170002-01","Standard Platinum On Exchange Plan","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170003","Health Net  PPO Platinum $15/$30/$500","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170003-01","Standard Platinum On Exchange Plan","88.40%","0.881154358386993","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$600","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170005","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170005-03","Limited Cost Sharing Plan Variation","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170006","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170006-00","Standard Gold Off Exchange Plan","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170006","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170006-01","Standard Gold On Exchange Plan","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","1","51485","AZ","Individual","No","73-0654885","51485AZ0170006","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160011","Health Net HSA Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","51485AZ0160011-01","Standard Silver On Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730004","EverydayHealth Alliance (Maricopa) 6000","53901AZ073",,"AZN002","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730004-01","Standard Bronze On Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","45"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730004","EverydayHealth Alliance (Maricopa) 6000","53901AZ073",,"AZN002","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","46"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730004","EverydayHealth Alliance (Maricopa) 6000","53901AZ073",,"AZN002","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730004-03","Limited Cost Sharing Plan Variation","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","47"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740001","EverydayHealth Select (Maricopa) 1000","53901AZ074",,"AZN003","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740001-00","Standard Gold Off Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","48"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740001","EverydayHealth Select (Maricopa) 1000","53901AZ074",,"AZN003","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740001-01","Standard Gold On Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","49"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-00","Standard Silver Off Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","52"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-01","Standard Silver On Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","53"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-06","94% AV Level Silver Plan","93.19%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$200","$400","10%",,,,"$700","$1,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$500","$150","$200","$440","$70","$80","14"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-00","Standard Silver Off Exchange Plan","69.18%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$40","$230","$150","$900","$820","$0","$80","15"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-04","73% AV Level Silver Plan","73.47%","0.734674096107483","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$630","$150","$140","$1,740","$0","$80","56"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160017","Health Net PPO Gold $20/$40/$500","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","51485AZ0160017-00","Standard Gold Off Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-06","94% AV Level Silver Plan","95.00%","0.949264228343964","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","10%",,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160017","Health Net PPO Gold $20/$40/$500","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","51485AZ0160017-01","Standard Gold On Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170014","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170014-00","Standard Bronze Off Exchange Plan","58.00%","0.59587574005127","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160018","Health Net PPO Gold $20/$40/$1000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","51485AZ0160018-00","Standard Gold Off Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170014","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170014-01","Standard Bronze On Exchange Plan","58.00%","0.59587574005127","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160018","Health Net PPO Gold $20/$40/$1000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","51485AZ0160018-01","Standard Gold On Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170014","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160012","Health Net HSA Silver 20%/20%/$2000/$6350","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160012-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170011","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170011","Health Net  PPO Gold $25/$50/$1500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170011-03","Limited Cost Sharing Plan Variation","79.20%","0.792545557022095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170016","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170016-03","Limited Cost Sharing Plan Variation","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","5","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160011","Health Net HSA Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","51485AZ0160011-00","Standard Silver Off Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160025","Health Net HSA Silver 20%/20%/$2000/$6350","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160025-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160026","Health Net HSA Silver 20%/20%/$2000/$5000","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160026-00","Standard Silver Off Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160026","Health Net HSA Silver 20%/20%/$2000/$5000","51485AZ016",,"AZN001","AZS001","AZF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_silver_20_20_5000_2000_shop.pdf","www.healthnet.com/drugs","51485AZ0160026-01","Standard Silver On Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160030","Health Net Bronze 50%/50%/$5500","51485AZ016",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160030-00","Standard Bronze Off Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-00","Standard Silver Off Exchange Plan","68.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$50","$430","$150","$900","$1,090","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-01","Standard Silver On Exchange Plan","68.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$50","$430","$150","$900","$1,090","$0","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-03","Limited Cost Sharing Plan Variation","68.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$50","$430","$150","$900","$1,090","$0","$80","11"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-04","73% AV Level Silver Plan","73.89%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$30","$530","$150","$900","$790","$0","$80","12"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540002","Essential 3000","53901AZ054",,"AZN001","AZS001","AZF010","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540002-05","87% AV Level Silver Plan","87.18%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$1,750","$3,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$30","$390","$150","$900","$750","$0","$80","13"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","6","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160030","Health Net Bronze 50%/50%/$5500","51485AZ016",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_ppo_HSA_bronze_50_50_5500_6350_shop.pdf","www.healthnet.com/drugs","51485AZ0160030-01","Standard Bronze On Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","52147","HIOS","2","2013-07-01 08:34:30","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0040002","EHB High PPO","52147AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"52147AZ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","54"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-03","Limited Cost Sharing Plan Variation","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","55"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540001","Essential 1500","53901AZ054",,"AZN001","AZS001","AZF030","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540001","Essential 1500","53901AZ054",,"AZN001","AZS001","AZF030","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540001-03","Limited Cost Sharing Plan Variation","79.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$50","$730","$150","$900","$1,080","$0","$80","7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170012","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170012-00","Standard Gold Off Exchange Plan","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170012","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170012-01","Standard Gold On Exchange Plan","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-03","Limited Cost Sharing Plan Variation","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","18"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-04","73% AV Level Silver Plan","72.32%","0.723236978054047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$70","$330","$150","$140","$1,500","$0","$80","19"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170010","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170010","Health Net  PPO Gold $25/$50/$2500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_2500_iex.pdf","www.healthnet.com/drugs","51485AZ0170010-03","Limited Cost Sharing Plan Variation","78.40%","0.784216463565826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160016","Health Net PPO Platinum $15/$30/$750","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","51485AZ0160016-00","Standard Platinum Off Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160016","Health Net PPO Platinum $15/$30/$750","51485AZ016",,"AZN001","AZS001","AZF001","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","51485AZ0160016-01","Standard Platinum On Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170013","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170013-05","87% AV Level Silver Plan","87.80%","0.876164734363556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","Individual","No","73-0654885","51485AZ0170014","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170014-03","Limited Cost Sharing Plan Variation","58.00%","0.59587574005127","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160019","Health Net PPO Gold $20/$40/$2000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","51485AZ0160019-00","Standard Gold Off Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","2","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160019","Health Net PPO Gold $20/$40/$2000","51485AZ016",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","51485AZ0160019-01","Standard Gold On Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160007","Health Net PPO Silver 20%/20%/$1500","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160007-00","Standard Silver Off Exchange Plan","71.30%","0.71314263343811","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170007","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170007-00","Standard Platinum Off Exchange Plan","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160007","Health Net PPO Silver 20%/20%/$1500","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160007-01","Standard Silver On Exchange Plan","71.30%","0.71314263343811","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170007","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170007-01","Standard Platinum On Exchange Plan","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160008","Health Net PPO Silver 20%/20%/$2000","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160008-00","Standard Silver Off Exchange Plan","69.20%","0.692435443401337","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170007","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160008","Health Net PPO Silver 20%/20%/$2000","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160008-01","Standard Silver On Exchange Plan","69.20%","0.692435443401337","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170007","Health Net  PPO Platinum $15/$30/$1000","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_1000_iex.pdf","www.healthnet.com/drugs","51485AZ0170007-03","Limited Cost Sharing Plan Variation","89.30%","0.916347205638886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160009","Health Net PPO Silver 30%/30%/$1500","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160009-00","Standard Silver Off Exchange Plan","69.30%","0.692543804645538","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170008","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170008-00","Standard Platinum Off Exchange Plan","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160009","Health Net PPO Silver 30%/30%/$1500","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160009-01","Standard Silver On Exchange Plan","69.30%","0.692543804645538","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170008","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170008-01","Standard Platinum On Exchange Plan","90.50%","0.900174260139465","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$400","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160010","Health Net PPO Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_shop.pdf","www.healthnet.com/drugs","51485AZ0160010-00","Standard Silver Off Exchange Plan","68.10%","0.681479394435883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170008","Health Net PPO Platinum $15/$30/$750","51485AZ017",,"AZN001","AZS001","AZF002","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_platinum_15_30_750_iex.pdf","www.healthnet.com/drugs","51485AZ0170008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170012","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","3","51485","AZ","Individual","No","73-0654885","51485AZ0170012","Health Net  PPO Gold $25/$50/$500","51485AZ017",,"AZN001","AZS001","AZF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_gold_25_50_500_iex.pdf","www.healthnet.com/drugs","51485AZ0170012-03","Limited Cost Sharing Plan Variation","81.90%","0.818767726421356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-00","Standard Silver Off Exchange Plan","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160020","Health Net PPO Silver 20%/20%/$1500","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160020-00","Standard Silver Off Exchange Plan","71.30%","0.71314263343811","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-01","Standard Silver On Exchange Plan","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160020","Health Net PPO Silver 20%/20%/$1500","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160020-01","Standard Silver On Exchange Plan","71.30%","0.71314263343811","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160021","Health Net PPO Silver 20%/20%/$2000","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160021-00","Standard Silver Off Exchange Plan","69.20%","0.692435443401337","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160021","Health Net PPO Silver 20%/20%/$2000","51485AZ016",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_20_20_2000_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160021-01","Standard Silver On Exchange Plan","69.20%","0.692435443401337","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-03","Limited Cost Sharing Plan Variation","68.20%","0.682598233222961","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160022","Health Net PPO Silver 30%/30%/$1500","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160022-00","Standard Silver Off Exchange Plan","69.30%","0.692543804645538","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-04","73% AV Level Silver Plan","73.90%","0.727959990501404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,200","$20,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160022","Health Net PPO Silver 30%/30%/$1500","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_1500_6000_shop.pdf","www.healthnet.com/drugs","51485AZ0160022-01","Standard Silver On Exchange Plan","69.30%","0.692543804645538","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-05","87% AV Level Silver Plan","87.80%","0.876164734363556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","20%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160023","Health Net PPO Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_shop.pdf","www.healthnet.com/drugs","51485AZ0160023-00","Standard Silver Off Exchange Plan","68.10%","0.681479394435883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170015","Health Net HSA PPO Silver 30%/30%/$1500","51485AZ017",,"AZN001","AZS001","AZF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_hsa_silver_30_30_1500_iex.pdf","www.healthnet.com/drugs","51485AZ0170015-06","94% AV Level Silver Plan","95.00%","0.949264228343964","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","10%",,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","SHOP (Small Group)","No","73-0654885","51485AZ0160023","Health Net PPO Silver 30%/30%/$2000","51485AZ016",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_PPO_silver_30_30_2000_5500_shop.pdf","www.healthnet.com/drugs","51485AZ0160023-01","Standard Silver On Exchange Plan","68.10%","0.681479394435883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170016","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170016-00","Standard Bronze Off Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170016","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170016-01","Standard Bronze On Exchange Plan","58.00%","0.595875918865204","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","51485","HIOS","13","2014-03-19 07:06:49","4","51485","AZ","Individual","No","73-0654885","51485AZ0170016","Health Net PPO Bronze 50%/50%/$5500","51485AZ017",,"AZN001","AZS001","AZF013","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","1","2014-01-01",,"No",,"Yes","Services provided outside network when appropriate","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_ppo_bronze_50_50_5500_iex.pdf","www.healthnet.com/drugs","51485AZ0170016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540001","Essential 1500","53901AZ054",,"AZN001","AZS001","AZF030","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540001-00","Standard Gold Off Exchange Plan","79.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$50","$730","$150","$900","$1,080","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540001","Essential 1500","53901AZ054",,"AZN001","AZS001","AZF030","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540001-01","Standard Gold On Exchange Plan","79.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$50","$730","$150","$900","$1,080","$0","$80","5"
"2014","AZ","52147","HIOS","2","2013-07-01 08:34:30","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0040001","EHB Low PPO","52147AZ004",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"52147AZ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","52147","HIOS","2","2013-07-01 08:34:30","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0030002","EHB High Passive","52147AZ003",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"52147AZ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740004","EverydayHealth Select (Maricopa) 6000","53901AZ074",,"AZN003","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740004-01","Standard Bronze On Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","67"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740004","EverydayHealth Select (Maricopa) 6000","53901AZ074",,"AZN003","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","68"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740004","EverydayHealth Select (Maricopa) 6000","53901AZ074",,"AZN003","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740004-03","Limited Cost Sharing Plan Variation","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","69"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-01","Standard Silver On Exchange Plan","69.18%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$40","$230","$150","$900","$820","$0","$80","16"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-06","94% AV Level Silver Plan","93.20%","0.932036876678467","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$100","$200","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$20","$510","$150","$100","$530","$0","$80","58"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-00","Standard Silver Off Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","59"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-01","Standard Silver On Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","60"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","61"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-03","Limited Cost Sharing Plan Variation","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","62"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-04","73% AV Level Silver Plan","72.32%","0.723236978054047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$70","$330","$150","$140","$1,500","$0","$80","63"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth 1000","53901AZ079",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-00","Standard Gold Off Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530001","EverydayHealth 1000","53901AZ053",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530001-00","Standard Gold Off Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790001","EverydayHealth 1000","53901AZ079",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790001-01","Standard Gold On Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","5"
"2014","AZ","52147","HIOS","2","2013-07-01 08:34:30","1","52147","AZ","SHOP (Small Group)","Yes","93-0242990","52147AZ0030001","EHB Low Passive","52147AZ003",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.88",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"52147AZ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-01","Standard Silver On Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","38"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","39"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-03","Limited Cost Sharing Plan Variation","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","40"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-04","73% AV Level Silver Plan","72.32%","0.723236978054047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$70","$330","$150","$140","$1,500","$0","$80","41"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-05","87% AV Level Silver Plan","86.35%","0.863474726676941","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$1,750","$3,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$30","$390","$150","$140","$640","$0","$80","42"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-06","94% AV Level Silver Plan","93.03%","0.93030172586441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$50","$100","10%",,,,"$550","$1,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$20","$510","$150","$50","$520","$10","$80","43"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730004","EverydayHealth Alliance (Maricopa) 6000","53901AZ073",,"AZN002","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730004-00","Standard Bronze Off Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","44"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740002","EverydayHealth Select (Maricopa) 3000","53901AZ074",,"AZN003","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740002-05","87% AV Level Silver Plan","86.38%","0.863824009895325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$900","$1,800","10%",,,,"$1,400","$2,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$40","$430","$150","$140","$920","$0","$80","57"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-05","87% AV Level Silver Plan","86.35%","0.863474726676941","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$1,750","$3,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$30","$390","$150","$140","$640","$0","$80","64"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740003","EverydayHealth Select (Maricopa) 4000","53901AZ074",,"AZN003","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740003-06","94% AV Level Silver Plan","93.03%","0.93030172586441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$50","$100","10%",,,,"$550","$1,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$20","$510","$150","$50","$520","$10","$80","65"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740004","EverydayHealth Select (Maricopa) 6000","53901AZ074",,"AZN003","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740004-00","Standard Bronze Off Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","66"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-03","Limited Cost Sharing Plan Variation","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","33"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-04","73% AV Level Silver Plan","73.47%","0.734674096107483","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$630","$150","$140","$1,740","$0","$80","34"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550001","FitRewards 1500","53901AZ055",,"AZN001","AZS001","AZF008","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9885",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550001-03","Limited Cost Sharing Plan Variation","78.40%","0.784040689468384","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,500","$150","$1,150","$750","$0","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-00","Standard Silver Off Exchange Plan","68.38%","0.683770537376404","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$1,150","$1,000","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-01","Standard Silver On Exchange Plan","68.38%","0.683770537376404","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$1,150","$1,000","$0","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-03","Limited Cost Sharing Plan Variation","68.38%","0.683770537376404","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$850","$150","$1,150","$1,000","$0","$80","11"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-01","Standard Silver On Exchange Plan",,"0.6833655834198","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$2,500","$0","$960","$150","$2,500","$0","$550","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-04","73% AV Level Silver Plan","72.37%","0.723731398582459","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,050","$150","$1,150","$1,000","$0","$80","12"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-05","87% AV Level Silver Plan","86.17%","0.86170095205307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$630","$150","$1,000","$720","$10","$80","13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$3,500","$0","$0","$150","$3,500","$0","$0","$80","18"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"$3,250","$6,500","Not Applicable","Not Applicable","$2,750","$0","$0","$150","$2,750","$0","$0","$80","19"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$1,600","$3,200","Not Applicable","Not Applicable","$1,100","$0","$0","$150","$1,100","$0","$0","$80","20"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$0","$0","$150","$500","$0","$0","$80","21"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-05","87% AV Level Silver Plan","86.38%","0.863824009895325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$900","$1,800","10%",,,,"$1,400","$2,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$40","$430","$150","$140","$920","$0","$80","35"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-06","94% AV Level Silver Plan","93.20%","0.932036876678467","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$100","$200","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$20","$510","$150","$100","$530","$0","$80","36"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730003","EverydayHealth Alliance (Maricopa) 4000","53901AZ073",,"AZN002","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730003-00","Standard Silver Off Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","37"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740001","EverydayHealth Select (Maricopa) 1000","53901AZ074",,"AZN003","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","50"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0740001","EverydayHealth Select (Maricopa) 1000","53901AZ074",,"AZN003","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthSelect1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0740001-03","Limited Cost Sharing Plan Variation","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","51"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-03","Limited Cost Sharing Plan Variation","69.18%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$40","$230","$150","$900","$820","$0","$80","18"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-04","73% AV Level Silver Plan","72.87%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$30","$430","$150","$900","$790","$0","$80","19"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-05","87% AV Level Silver Plan","86.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$420","$150","$900","$440","$0","$80","20"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540003","Essential 4000","53901AZ054",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540003-06","94% AV Level Silver Plan","93.25%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$520","$150","$0","$440","$90","$80","21"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540004","Essential 6000","53901AZ054",,"AZN001","AZS001","AZF020","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540004-00","Standard Bronze Off Exchange Plan","61.63%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$60","$0","$150","$900","$1,590","$0","$80","22"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540004","Essential 6000","53901AZ054",,"AZN001","AZS001","AZF020","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540004-01","Standard Bronze On Exchange Plan","61.63%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$60","$0","$150","$900","$1,590","$0","$80","23"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540004","Essential 6000","53901AZ054",,"AZN001","AZS001","AZF020","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","24"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530001","EverydayHealth 1000","53901AZ053",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530001-01","Standard Gold On Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530001","EverydayHealth 1000","53901AZ053",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth 2000","53901AZ079",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth2000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-00","Standard Silver Off Exchange Plan","69.27%","0.692728817462921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$80","$950","$150","$140","$2,080","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530001","EverydayHealth 1000","53901AZ053",,"AZN001","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530001-03","Limited Cost Sharing Plan Variation","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790002","EverydayHealth 2000","53901AZ079",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth2000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790002-01","Standard Silver On Exchange Plan","69.27%","0.692728817462921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$80","$950","$150","$140","$2,080","$0","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth 6000","53901AZ079",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-00","Standard Bronze Off Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-00","Standard Silver Off Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","SHOP (Small Group)","No","86-0004538","53901AZ0790004","EverydayHealth 6000","53901AZ079",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000SHOP","www.azblue.com/payment","www.azblue.com/brochure/smallgroupbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0790004-01","Standard Bronze On Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-01","Standard Silver On Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-03","Limited Cost Sharing Plan Variation","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","11"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-04","73% AV Level Silver Plan","73.47%","0.734674096107483","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$630","$150","$140","$1,740","$0","$80","12"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-05","87% AV Level Silver Plan","86.38%","0.863824009895325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$900","$1,800","10%",,,,"$1,400","$2,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$40","$430","$150","$140","$920","$0","$80","13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530002","EverydayHealth 3000","53901AZ053",,"AZN001","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530002-06","94% AV Level Silver Plan","93.20%","0.932036876678467","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$100","$200","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$20","$510","$150","$100","$530","$0","$80","14"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-00","Standard Silver Off Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","15"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-01","Standard Silver On Exchange Plan","68.45%","0.684538066387177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$80","$230","$150","$140","$1,600","$0","$80","16"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-05","87% AV Level Silver Plan","86.35%","0.863474726676941","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$1,750","$3,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$30","$390","$150","$140","$640","$0","$80","20"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530003","EverydayHealth 4000","53901AZ053",,"AZN001","AZS001","AZF013","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530003-06","94% AV Level Silver Plan","93.03%","0.93030172586441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$50","$100","10%",,,,"$550","$1,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$20","$510","$150","$50","$520","$10","$80","21"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530004","EverydayHealth 6000","53901AZ053",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530004-00","Standard Bronze Off Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","22"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530004","EverydayHealth 6000","53901AZ053",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530004-01","Standard Bronze On Exchange Plan","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","23"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530004","EverydayHealth 6000","53901AZ053",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","24"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0530004","EverydayHealth 6000","53901AZ053",,"AZN001","AZS001","AZF021","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealth6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0530004-03","Limited Cost Sharing Plan Variation","61.03%","0.610330104827881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$100","$0","$150","$140","$2,250","$0","$80","25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730001","EverydayHealth Alliance (Maricopa) 1000","53901AZ073",,"AZN002","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730001-00","Standard Gold Off Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","26"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730001","EverydayHealth Alliance (Maricopa) 1000","53901AZ073",,"AZN002","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730001-01","Standard Gold On Exchange Plan","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","27"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730001","EverydayHealth Alliance (Maricopa) 1000","53901AZ073",,"AZN002","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","28"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730001","EverydayHealth Alliance (Maricopa) 1000","53901AZ073",,"AZN002","AZS001","AZF009","New","PPO","Gold","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance1000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730001-03","Limited Cost Sharing Plan Variation","78.53%","0.785332977771759","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$60","$830","$150","$140","$1,400","$0","$80","29"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-00","Standard Silver Off Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","30"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-01","Standard Silver On Exchange Plan","71.36%","0.713595628738403","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$80","$430","$150","$140","$2,080","$0","$80","31"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","1","53901","AZ","Individual","No","86-0004538","53901AZ0730002","EverydayHealth Alliance (Maricopa) 3000","53901AZ073",,"AZN002","AZS001","AZF019","New","PPO","Silver","Yes","Both","Yes","No",,"See the Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/EverydayHealthAlliance3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0730002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","32"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","2","53901","AZ","Individual","No","86-0004538","53901AZ0540004","Essential 6000","53901AZ054",,"AZN001","AZS001","AZF020","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Essential6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0540004-03","Limited Cost Sharing Plan Variation","61.63%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,170","$60","$0","$150","$900","$1,590","$0","$80","25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550001","FitRewards 1500","53901AZ055",,"AZN001","AZS001","AZF008","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9885",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550001-00","Standard Gold Off Exchange Plan","78.40%","0.784040689468384","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,500","$150","$1,150","$750","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550001","FitRewards 1500","53901AZ055",,"AZN001","AZS001","AZF008","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9885",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550001-01","Standard Gold On Exchange Plan","78.40%","0.784040689468384","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,500","$150","$1,150","$750","$0","$80","5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550001","FitRewards 1500","53901AZ055",,"AZN001","AZS001","AZF008","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9885",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550002","FitRewards 3000","53901AZ055",,"AZN001","AZS001","AZF014","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9861",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards3000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550002-06","94% AV Level Silver Plan","93.33%","0.933252453804016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$100","$200","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$10","$720","$150","$100","$420","$110","$80","14"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-00","Standard Silver Off Exchange Plan","68.07%","0.680670917034149","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$650","$150","$1,150","$750","$0","$80","15"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-03","Limited Cost Sharing Plan Variation",,"0.6833655834198","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$2,500","$0","$960","$150","$2,500","$0","$550","$80","11"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-04","73% AV Level Silver Plan",,"0.726126849651337","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$1,750","$0","$1,110","$150","$1,750","$0","$700","$80","12"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-05","87% AV Level Silver Plan",,"0.863306164741516","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"$1,250","$2,500","Not Applicable","Not Applicable","$750","$0","$650","$150","$750","$0","$450","$80","13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-06","94% AV Level Silver Plan",,"0.933740496635437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$100","$0","$720","$150","$100","$0","$520","$80","14"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$3,500","$0","$0","$150","$3,500","$0","$0","$80","15"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580001","CopayComplete 20","53901AZ058",,"AZN001","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040001","myCigna Health Savings 6100","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040001-01","Standard Bronze On Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","Yes","59-1031071","86830AZ0050001","myCigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"86830AZ0050001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040001","myCigna Health Savings 6100","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040001","myCigna Health Savings 6100","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040001-03","Limited Cost Sharing Plan Variation","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","2","70239","AZ","Individual","No","46-2210067","70239AZ0010002","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","2","70239","AZ","Individual","No","46-2210067","70239AZ0010002","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010002-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-01","Standard Silver On Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","9"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750001","CopayComplete Alliance (Maricopa) 20","53901AZ075",,"AZN002","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-00","Standard Silver Off Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-01","Standard Silver On Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","1","70239","AZ","Individual","No","46-2210067","70239AZ0010001","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010001-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","2","70239","AZ","Individual","No","46-2210067","70239AZ0010002","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010002-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","2","86830","AZ","Individual","Yes","59-1031071","86830AZ0050002","myCigna Dental Family + Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"86830AZ0050002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","2","86830","AZ","Individual","No","59-1031071","86830AZ0040002","myCigna Health Flex 5500","86830AZ004","7730182962","AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040002-01","Standard Bronze On Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0120001","Meritus Gold Cooperatively","60761AZ012",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994904590161065",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0120001-00","Standard Gold Off Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0040001","Meritus Cooperatively Together Gold","60761AZ004",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994687659613418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0040001-00","Standard Gold Off Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-00","Standard Silver Off Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-01","Standard Silver On Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-00","Standard Silver Off Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-01","Standard Silver On Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Dental Advantage - Gold","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"77352AZ0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010004","BEST Dental Plus - Gold","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Gold).pdf",,"77352AZ0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Dental Plus - Gold","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"77352AZ0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760001","CopayComplete Select (Maricopa) 20","53901AZ076",,"AZN003","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760001-01","Standard Gold On Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","27"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760001","CopayComplete Select (Maricopa) 20","53901AZ076",,"AZN003","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","28"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760001","CopayComplete Select (Maricopa) 20","53901AZ076",,"AZN003","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760001-03","Limited Cost Sharing Plan Variation","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","29"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0030001","Meritus Healthy Together Gold","60761AZ003",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.974934335797475",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0030001-03","Limited Cost Sharing Plan Variation","81.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0060001","Meritus Cooperatively Silver","60761AZ006",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$32.87","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.993835640586716",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0060001-03","Limited Cost Sharing Plan Variation","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-01","Standard Silver On Exchange Plan","68.07%","0.680670917034149","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$650","$150","$1,150","$750","$0","$80","16"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-03","Limited Cost Sharing Plan Variation","68.07%","0.680670917034149","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$650","$150","$1,150","$750","$0","$80","18"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-04","73% AV Level Silver Plan","73.01%","0.730096280574799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$950","$150","$1,150","$750","$0","$80","19"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-03","Limited Cost Sharing Plan Variation","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","11"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,150","$0","$80","12"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-05","87% AV Level Silver Plan","87.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$810","$0","$150","$0","$1,180","$0","$80","13"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-06","94% AV Level Silver Plan","93.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$380","$0","$150","$0","$590","$0","$80","14"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750001","CopayComplete Alliance (Maricopa) 20","53901AZ075",,"AZN002","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750001-00","Standard Gold Off Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","15"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750001","CopayComplete Alliance (Maricopa) 20","53901AZ075",,"AZN002","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750001-01","Standard Gold On Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","16"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-05","87% AV Level Silver Plan","86.02%","0.860247671604156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$10","$630","$150","$1,000","$430","$20","$80","20"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550003","FitRewards 4000","53901AZ055",,"AZN001","AZS001","AZF007","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards4000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550003-06","94% AV Level Silver Plan","93.01%","0.930055320262909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$70","$140","10%",,,,"$570","$1,140","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$720","$150","$70","$130","$110","$80","21"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$3,500","$0","$0","$150","$3,500","$0","$0","$80","16"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560003","Portfolio HSA 3500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio3500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560004","Portfolio HSA 5500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Bronze","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio5500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560004-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$5,270","$0","$0","$80","22"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560004","Portfolio HSA 5500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Bronze","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio5500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560004-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$5,270","$0","$0","$80","23"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560004","Portfolio HSA 5500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Bronze","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio5500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","24"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560004","Portfolio HSA 5500","53901AZ056",,"AZN001","AZS001","AZF027","New","PPO","Bronze","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio5500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560004-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$5,270","$0","$0","$80","25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580001","CopayComplete 20","53901AZ058",,"AZN001","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580001-00","Standard Gold Off Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580001","CopayComplete 20","53901AZ058",,"AZN001","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580001-01","Standard Gold On Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550004","FitRewards 6000","53901AZ055",,"AZN001","AZS001","AZF015","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9835",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550004-00","Standard Bronze Off Exchange Plan","61.01%","0.610110402107239","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$350","$150","$1,150","$1,000","$0","$80","22"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550004","FitRewards 6000","53901AZ055",,"AZN001","AZS001","AZF015","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9835",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550004-01","Standard Bronze On Exchange Plan","61.01%","0.610110402107239","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$350","$150","$1,150","$1,000","$0","$80","23"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550004","FitRewards 6000","53901AZ055",,"AZN001","AZS001","AZF015","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9835",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","24"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","3","53901","AZ","Individual","No","86-0004538","53901AZ0550004","FitRewards 6000","53901AZ055",,"AZN001","AZS001","AZF015","New","PPO","Bronze","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9835",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/FitRewards6000","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0550004-03","Limited Cost Sharing Plan Variation","61.01%","0.610110402107239","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$350","$150","$1,150","$1,000","$0","$80","25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560001","Portfolio HSA 1500","53901AZ056",,"AZN001","AZS001","AZF031","New","PPO","Gold","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560001-00","Standard Gold Off Exchange Plan",,"0.781491816043854","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,500","$0","$580","$150","$1,500","$0","$380","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560001","Portfolio HSA 1500","53901AZ056",,"AZN001","AZS001","AZF031","New","PPO","Gold","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560001-01","Standard Gold On Exchange Plan",,"0.781491816043854","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,500","$0","$580","$150","$1,500","$0","$380","$80","5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560001","Portfolio HSA 1500","53901AZ056",,"AZN001","AZS001","AZF031","New","PPO","Gold","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560001","Portfolio HSA 1500","53901AZ056",,"AZN001","AZS001","AZF031","New","PPO","Gold","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio1500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560001-03","Limited Cost Sharing Plan Variation",,"0.781491816043854","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,500","$0","$580","$150","$1,500","$0","$380","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","4","53901","AZ","Individual","No","86-0004538","53901AZ0560002","Portfolio HSA 2500","53901AZ056",,"AZN001","AZS001","AZF028","New","PPO","Silver","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/Portfolio2500","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0560002-00","Standard Silver Off Exchange Plan",,"0.6833655834198","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$2,500","$0","$960","$150","$2,500","$0","$550","$80","8"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-03","Limited Cost Sharing Plan Variation","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-04","73% AV Level Silver Plan","72.50%","0.73218709230423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-05","87% AV Level Silver Plan","86.00%","0.865245342254639","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-06","94% AV Level Silver Plan","93.10%","0.933359861373901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","18","70239","AZ","Individual","No","46-2210067","70239AZ0010018","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","18","70239","AZ","Individual","No","46-2210067","70239AZ0010018","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010018-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,150","$0","$80","23"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-05","87% AV Level Silver Plan","87.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$810","$0","$150","$0","$1,180","$0","$80","24"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-06","94% AV Level Silver Plan","93.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$380","$0","$150","$0","$590","$0","$80","25"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760001","CopayComplete Select (Maricopa) 20","53901AZ076",,"AZN003","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760001-00","Standard Gold Off Exchange Plan","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","26"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0120001","Meritus Gold Cooperatively","60761AZ012",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994904590161065",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0120001-01","Standard Gold On Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0040001","Meritus Cooperatively Together Gold","60761AZ004",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994687659613418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0040001-01","Standard Gold On Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0130001","Meritus Silver Healthy","60761AZ013",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.972241501190706",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0130001-01","Standard Silver On Exchange Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-03","Limited Cost Sharing Plan Variation","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","32","70239","AZ","Individual","No","46-2210067","70239AZ0010032","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010012","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010012-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010012","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010012-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010005","BEST Dental Plus - Silver","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","Individual","Yes","95-6042390","77352AZ0020005","BEST Dental Plus - Silver","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010006","BEST Dental Basic - Silver","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-06","94% AV Level Silver Plan","93.40%","0.93491131067276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$620","$1,240",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040009","myCigna Health Flex 1250","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040009-00","Standard Gold Off Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","28","70239","AZ","Individual","No","46-2210067","70239AZ0010028","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010028-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","29","70239","AZ","Individual","No","46-2210067","70239AZ0010029","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010029-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","29","70239","AZ","Individual","No","46-2210067","70239AZ0010029","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","29","70239","AZ","Individual","No","46-2210067","70239AZ0010029","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS008","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010029-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580001","CopayComplete 20","53901AZ058",,"AZN001","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580001-03","Limited Cost Sharing Plan Variation","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0580002","CopayComplete 40","53901AZ058",,"AZN001","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayComplete40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0580002-00","Standard Silver Off Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750001","CopayComplete Alliance (Maricopa) 20","53901AZ075",,"AZN002","AZS001","AZF011","New","PPO","Gold","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance20","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750001-03","Limited Cost Sharing Plan Variation","79.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,390","$0","$150","$0","$1,640","$0","$80","18"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-00","Standard Silver Off Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","19"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-01","Standard Silver On Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","20"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","21"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0750002","CopayComplete Alliance (Maricopa) 40","53901AZ075",,"AZN002","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteAlliance40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0750002-03","Limited Cost Sharing Plan Variation","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","22"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-00","Standard Silver Off Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","30"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-01","Standard Silver On Exchange Plan","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","31"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","32"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-03","Limited Cost Sharing Plan Variation","71.85%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,390","$0","$80","33"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,560","$0","$150","$0","$2,150","$0","$80","34"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-05","87% AV Level Silver Plan","87.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$810","$0","$150","$0","$1,180","$0","$80","35"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","5","53901","AZ","Individual","No","86-0004538","53901AZ0760002","CopayComplete Select (Maricopa) 40","53901AZ076",,"AZN003","AZS001","AZF022","New","PPO","Silver","Yes","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"4","0","0","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/CopayCompleteSelect40","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelect3tierFormulary","53901AZ0760002-06","94% AV Level Silver Plan","93.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$380","$0","$150","$0","$590","$0","$80","36"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0570001","SimpleHealth","53901AZ057",,"AZN001","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealth","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0570001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0570001","SimpleHealth","53901AZ057",,"AZN001","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealth","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0570001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0770001","SimpleHealth Alliance (Maricopa)","53901AZ077",,"AZN002","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealthAlliance","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0770001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","6"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0770001","SimpleHealth Alliance (Maricopa)","53901AZ077",,"AZN002","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies Only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealthAlliance","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0770001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","7"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0780001","SimpleHealth Select (Maricopa)","53901AZ078",,"AZN003","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealthSelect","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0780001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","8"
"2014","AZ","53901","HIOS","7","2014-01-16 07:24:04","6","53901","AZ","Individual","No","86-0004538","53901AZ0780001","SimpleHealth Select (Maricopa)","53901AZ078",,"AZN003","AZS001","AZF027","New","PPO","Catastrophic","No","Both","Yes","No",,"See Summary of Benefits and Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergencies only","Yes","All benefits","Yes","www.azblue.com/plans/SimpleHealthSelect","www.azblue.com/payment","www.azblue.com/brochure/individualbrochure","http://azblue.com/BlueExchangeSelectFormulary","53901AZ0780001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,850","$13,700","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,270","$0","$0","$80","9"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020001",,"58292AZ0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","Individual","Yes","75-1233841","58292AZ0010001","Dentegra Dental PPO Children's Plan 70","58292AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010001",,"58292AZ0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","Individual","Yes","75-1233841","58292AZ0010001","Dentegra Dental PPO Children's Plan 70","58292AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010001",,"58292AZ0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020001",,"58292AZ0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020002",,"58292AZ0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","Individual","Yes","75-1233841","58292AZ0010002","Dentegra Dental PPO Children's Plan 85","58292AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010002",,"58292AZ0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","Individual","Yes","75-1233841","58292AZ0010002","Dentegra Dental PPO Children's Plan 85","58292AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010002",,"58292AZ0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","1","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020002",,"58292AZ0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","2","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020006",,"58292AZ0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","2","58292","AZ","Individual","Yes","75-1233841","58292AZ0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","58292AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010006",,"58292AZ0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","2","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020006",,"58292AZ0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","2","58292","AZ","Individual","Yes","75-1233841","58292AZ0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","58292AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010006",,"58292AZ0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","3","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020004",,"58292AZ0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","3","58292","AZ","Individual","Yes","75-1233841","58292AZ0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","58292AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010004",,"58292AZ0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","3","58292","AZ","SHOP (Small Group)","Yes","75-1233841","58292AZ0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","58292AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/az/58292az0020004",,"58292AZ0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","58292","HIOS","7","2014-01-17 09:36:20","3","58292","AZ","Individual","Yes","75-1233841","58292AZ0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","58292AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.56",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/az/58292az0010004",,"58292AZ0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0030001","Meritus Healthy Together Gold","60761AZ003",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.974934335797475",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0030001-00","Standard Gold Off Exchange Plan","81.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0110001","Meritus Gold Healthy","60761AZ011",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.975985704214206",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0110001-00","Standard Gold Off Exchange Plan","81.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0110001","Meritus Gold Healthy","60761AZ011",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.975985704214206",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0110001-01","Standard Gold On Exchange Plan","81.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0030001","Meritus Healthy Together Gold","60761AZ003",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.974934335797475",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0030001-01","Standard Gold On Exchange Plan","81.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0130001","Meritus Silver Healthy","60761AZ013",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.972241501190706",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0130001-00","Standard Silver Off Exchange Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0030001","Meritus Healthy Together Gold","60761AZ003",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.974934335797475",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-00","Standard Silver Off Exchange Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-01","Standard Silver On Exchange Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","1","60761","AZ","Individual","No","46-1509576","60761AZ0050001","Meritus Healthy Together Silver","60761AZ005",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$26.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.971069154781438",,,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://www.meritushealthpartners.org/formulary.html","60761AZ0050001-03","Limited Cost Sharing Plan Variation","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0040001","Meritus Cooperatively Together Gold","60761AZ004",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994687659613418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0140001","Meritus Silver Together","60761AZ014",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994076985155348",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0140001-00","Standard Silver Off Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0140001","Meritus Silver Together","60761AZ014",,"AZN001","AZS004","AZF004","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994076985155348",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0140001-01","Standard Silver On Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0040001","Meritus Cooperatively Together Gold","60761AZ004",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.994687659613418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://meritusaz.com/formulary.html","60761AZ0040001-03","Limited Cost Sharing Plan Variation","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","3","70239","AZ","Individual","No","46-2210067","70239AZ0010003","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010003-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","4","70239","AZ","Individual","No","46-2210067","70239AZ0010004","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010004-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","4","70239","AZ","Individual","No","46-2210067","70239AZ0010004","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","16","70239","AZ","Individual","No","46-2210067","70239AZ0010016","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","16","70239","AZ","Individual","No","46-2210067","70239AZ0010016","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010016-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","17","70239","AZ","Individual","No","46-2210067","70239AZ0010017","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010017-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","17","70239","AZ","Individual","No","46-2210067","70239AZ0010017","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-03","Limited Cost Sharing Plan Variation","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0080001","Meritus Neighborhood Network Maricopa Silver","60761AZ008",,"AZN002","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$23.63","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.991497287207379",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0080001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-00","Standard Silver Off Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-01","Standard Silver On Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0090001","Meritus Community Network - Phoenix","60761AZ009",,"AZN003","AZS001","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.9927168229925",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0090001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-00","Standard Silver Off Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-01","Standard Silver On Exchange Plan","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-03","Limited Cost Sharing Plan Variation","69.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","21","70239","AZ","Individual","No","46-2210067","70239AZ0010021","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS006","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010021-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","21","70239","AZ","Individual","No","46-2210067","70239AZ0010021","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS006","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","4","84251","AZ","Individual","No","06-6033492","84251AZ0070004","Aetna AdvantagePlus 5500 PD","84251AZ007",,"AZN001","AZS001","AZF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","5","84251","AZ","Individual","No","06-6033492","84251AZ0070008","Aetna Classic 3500 PD","84251AZ007",,"AZN001","AZS001","AZF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,200","$4,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","2","60761","AZ","Individual","No","46-1509576","60761AZ0100001","Meritus Community Network - Pima","60761AZ010",,"AZN004","AZS002","AZF003","New","HMO","Silver","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$27.93","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992772241670116",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0100001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","Individual","No","46-1509576","60761AZ0070001","Meritus Premium Saver Bronze","60761AZ007",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992459993980022",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0070001-00","Standard Bronze Off Exchange Plan","61.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0150001","Meritus Bronze Healthy Saver","60761AZ015",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992741463132488",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0150001-00","Standard Bronze Off Exchange Plan","61.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","Individual","No","46-1509576","60761AZ0070001","Meritus Premium Saver Bronze","60761AZ007",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992459993980022",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0070001-01","Standard Bronze On Exchange Plan","61.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","SHOP (Small Group)","No","46-1509576","60761AZ0150001","Meritus Bronze Healthy Saver","60761AZ015",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992741463132488",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0150001-01","Standard Bronze On Exchange Plan","61.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","Individual","No","46-1509576","60761AZ0070001","Meritus Premium Saver Bronze","60761AZ007",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992459993980022",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","60761","HIOS","5","2013-11-23 14:44:18","3","60761","AZ","Individual","No","46-1509576","60761AZ0070001","Meritus Premium Saver Bronze","60761AZ007",,"AZN001","AZS004","AZF002","New","HMO","Bronze","Yes","Both","Yes","Yes","Allergist, Tranplant Surgeon, Pain Management, Cardiac Surgeon, Sleep Studies, Plastics,Dermatologist Rehabilitation Services, Radiology and Imaging; Genetics",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.992459993980022",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/hmo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/hmo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","60761AZ0070001-03","Limited Cost Sharing Plan Variation","61.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","10","70239","AZ","Individual","No","46-2210067","70239AZ0010010","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","10","70239","AZ","Individual","No","46-2210067","70239AZ0010010","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010010-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","22","70239","AZ","Individual","No","46-2210067","70239AZ0010022","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010022-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","22","70239","AZ","Individual","No","46-2210067","70239AZ0010022","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","22","70239","AZ","Individual","No","46-2210067","70239AZ0010022","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010022-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010003","BEST Dental Advantage - Gold","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Advantage_Plan_(Gold).pdf",,"77352AZ0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","Individual","Yes","95-6042390","77352AZ0020003","BESTOne Dental Advantage - Gold","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"77352AZ0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010003","BEST Dental Advantage - Gold","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Advantage_Plan_(Gold).pdf",,"77352AZ0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","66105","HIOS","6","2014-03-19 07:06:49","1","66105","AZ","Individual","Yes","39-1263473","66105AZ0620001","Humana Dental Smart Choice","66105AZ062",,"AZN001","AZS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"66105AZ0620001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","1","70239","AZ","Individual","No","46-2210067","70239AZ0010001","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010001-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","1","70239","AZ","Individual","No","46-2210067","70239AZ0010001","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","16","70239","AZ","Individual","No","46-2210067","70239AZ0010016","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010016-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","17","70239","AZ","Individual","No","46-2210067","70239AZ0010017","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS005","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010017-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","18","70239","AZ","Individual","No","46-2210067","70239AZ0010018","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010018-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","4","70239","AZ","Individual","No","46-2210067","70239AZ0010004","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS001","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010004-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","5","70239","AZ","Individual","No","46-2210067","70239AZ0010005","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010005-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","5","70239","AZ","Individual","No","46-2210067","70239AZ0010005","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","5","70239","AZ","Individual","No","46-2210067","70239AZ0010005","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS002","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010005-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","6","70239","AZ","Individual","No","46-2210067","70239AZ0010006","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010006-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","6","70239","AZ","Individual","No","46-2210067","70239AZ0010006","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","6","70239","AZ","Individual","No","46-2210067","70239AZ0010006","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010006-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","7","70239","AZ","Individual","No","46-2210067","70239AZ0010007","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010007-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","8","70239","AZ","Individual","No","46-2210067","70239AZ0010008","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010008-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","8","70239","AZ","Individual","No","46-2210067","70239AZ0010008","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","8","70239","AZ","Individual","No","46-2210067","70239AZ0010008","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS002","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010008-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","9","70239","AZ","Individual","No","46-2210067","70239AZ0010009","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010009-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","9","70239","AZ","Individual","No","46-2210067","70239AZ0010009","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","9","70239","AZ","Individual","No","46-2210067","70239AZ0010009","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS003","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010009-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","10","70239","AZ","Individual","No","46-2210067","70239AZ0010010","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010010-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","11","70239","AZ","Individual","No","46-2210067","70239AZ0010011","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010011-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","12","70239","AZ","Individual","No","46-2210067","70239AZ0010012","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010012-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","12","70239","AZ","Individual","No","46-2210067","70239AZ0010012","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","12","70239","AZ","Individual","No","46-2210067","70239AZ0010012","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS003","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010012-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","13","70239","AZ","Individual","No","46-2210067","70239AZ0010013","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010013-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","13","70239","AZ","Individual","No","46-2210067","70239AZ0010013","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","13","70239","AZ","Individual","No","46-2210067","70239AZ0010013","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS004","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010013-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","14","70239","AZ","Individual","No","46-2210067","70239AZ0010014","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010014-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","14","70239","AZ","Individual","No","46-2210067","70239AZ0010014","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","14","70239","AZ","Individual","No","46-2210067","70239AZ0010014","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010014-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","15","70239","AZ","Individual","No","46-2210067","70239AZ0010015","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS004","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010015-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040008","myCigna Health Flex 1900","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040008-01","Standard Gold On Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040008","myCigna Health Flex 1900","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040008","myCigna Health Flex 1900","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040008-03","Limited Cost Sharing Plan Variation","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","2","86830","AZ","Individual","No","59-1031071","86830AZ0040002","myCigna Health Flex 5500","86830AZ004","7730182962","AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040002-00","Standard Bronze Off Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","2","86830","AZ","Individual","No","59-1031071","86830AZ0040002","myCigna Health Flex 5500","86830AZ004","7730182962","AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","2","86830","AZ","Individual","No","59-1031071","86830AZ0040002","myCigna Health Flex 5500","86830AZ004","7730182962","AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040002-03","Limited Cost Sharing Plan Variation","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","4","86830","AZ","Individual","No","59-1031071","86830AZ0040003","myCigna Health Flex 5100","86830AZ004","7730182962","AZN001","AZS001","AZF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040003-03","Limited Cost Sharing Plan Variation","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-00","Standard Silver Off Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-01","Standard Silver On Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040006","myCigna Health Flex 2750","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","30","70239","AZ","Individual","No","46-2210067","70239AZ0010030","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010030-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","19","70239","AZ","Individual","No","46-2210067","70239AZ0010019","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010019-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","20","70239","AZ","Individual","No","46-2210067","70239AZ0010020","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010020-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","20","70239","AZ","Individual","No","46-2210067","70239AZ0010020","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","20","70239","AZ","Individual","No","46-2210067","70239AZ0010020","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS005","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010020-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","21","70239","AZ","Individual","No","46-2210067","70239AZ0010021","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS006","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010021-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","31","70239","AZ","Individual","No","46-2210067","70239AZ0010031","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010031-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","32","70239","AZ","Individual","No","46-2210067","70239AZ0010032","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010032-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-03","Limited Cost Sharing Plan Variation","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-04","73% AV Level Silver Plan","73.20%","0.684354066848755","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-05","87% AV Level Silver Plan","86.60%","0.812985122203827","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040004","myCigna Health Savings 3400","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040004-06","94% AV Level Silver Plan","94.30%","0.861155152320862","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040008","myCigna Health Flex 1900","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040008-00","Standard Gold Off Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","23","70239","AZ","Individual","No","46-2210067","70239AZ0010023","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010023-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","24","70239","AZ","Individual","No","46-2210067","70239AZ0010024","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010024-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","24","70239","AZ","Individual","No","46-2210067","70239AZ0010024","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","24","70239","AZ","Individual","No","46-2210067","70239AZ0010024","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS006","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010024-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","25","70239","AZ","Individual","No","46-2210067","70239AZ0010025","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010025-01","Standard Platinum On Exchange Plan","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","25","70239","AZ","Individual","No","46-2210067","70239AZ0010025","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","25","70239","AZ","Individual","No","46-2210067","70239AZ0010025","Health Choice Essential Platinum","70239AZ001",,"AZN001","AZS007","AZF002","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010025-03","Limited Cost Sharing Plan Variation","88.10%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","26","70239","AZ","Individual","No","46-2210067","70239AZ0010026","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010026-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","26","70239","AZ","Individual","No","46-2210067","70239AZ0010026","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","26","70239","AZ","Individual","No","46-2210067","70239AZ0010026","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010026-03","Limited Cost Sharing Plan Variation","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-01","Standard Silver On Exchange Plan","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-03","Limited Cost Sharing Plan Variation","69.60%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"6"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-04","73% AV Level Silver Plan","72.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$1,250","$2,500","$1,250","$2,500",,,,,,,,,"7"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$150","$300","$150","$300",,,,,,,,,"8"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","27","70239","AZ","Individual","No","46-2210067","70239AZ0010027","Health Choice Essential Silver","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010027-06","94% AV Level Silver Plan","93.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","28","70239","AZ","Individual","No","46-2210067","70239AZ0010028","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010028-01","Standard Bronze On Exchange Plan","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","28","70239","AZ","Individual","No","46-2210067","70239AZ0010028","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS007","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","30","70239","AZ","Individual","No","46-2210067","70239AZ0010030","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010030-01","Standard Gold On Exchange Plan","79.40%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,"4"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","30","70239","AZ","Individual","No","46-2210067","70239AZ0010030","Health Choice Essential Gold","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AZ","70239","HIOS","10","2014-01-17 09:36:20","32","70239","AZ","Individual","No","46-2210067","70239AZ0010032","Health Choice Essential Bronze","70239AZ001",,"AZN001","AZS008","AZF001","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, OB/GYN and General Practitioner",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services","Yes","Out of Service Area Coverage is covered for any expense incurred for services received outside of the service area as required by law for emergency care services","No","http://www.healthchoiceessential.com/members/member_benefits","https://www.healthchoiceessential.com/EnrollmentPayment","http://www.healthchoiceessential.com/members","http://www.healthchoiceessential.com/members/rxdrugs","70239AZ0010032-03","Limited Cost Sharing Plan Variation","61.70%","0.61702686548233","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"6"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020001","BESTOne Child Dental Plus","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Child_Dental_Plus_Plan.pdf",,"77352AZ0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010001","BEST Life Child Dental Plus","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Child_Dental_Plus_Plan.pdf",,"77352AZ0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","1","77352","AZ","Individual","Yes","95-6042390","77352AZ0020001","BESTOne Child Dental Plus","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Child_Dental_Plus_Plan.pdf",,"77352AZ0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","1","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010001","BEST Life Child Dental Plus","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Child_Dental_Plus_Plan.pdf",,"77352AZ0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010002","BEST Life Child Dental","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Child_Dental_Plan.pdf",,"77352AZ0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020002","BESTOne Child Dental","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Child_Dental_Plan.pdf",,"77352AZ0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","2","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010002","BEST Life Child Dental","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Child_Dental_Plan.pdf",,"77352AZ0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","2","77352","AZ","Individual","Yes","95-6042390","77352AZ0020002","BESTOne Child Dental","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Child_Dental_Plan.pdf",,"77352AZ0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","Individual","Yes","95-6042390","77352AZ0020004","BESTOne Dental Plus - Gold","77352AZ002",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"77352AZ0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","3","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010004","BEST Dental Plus - Gold","77352AZ001",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Gold).pdf",,"77352AZ0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","Individual","Yes","95-6042390","77352AZ0020005","BEST Dental Plus - Silver","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010005","BEST Dental Plus - Silver","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","Individual","Yes","95-6042390","77352AZ0020006","BEST Dental Basic - Silver","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"77352AZ0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","SHOP (Small Group)","Yes","95-6042390","77352AZ0010006","BEST Dental Basic - Silver","77352AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BEST_Dental_Plus_Plan_(Silver).pdf",,"77352AZ0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","77352","HIOS","7","2014-01-21 08:29:49","4","77352","AZ","Individual","Yes","95-6042390","77352AZ0020006","BEST Dental Basic - Silver","77352AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AZ/pdf/AZ_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"77352AZ0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","1","84251","AZ","Individual","No","06-6033492","84251AZ0070001","Aetna Advantage 5750 PD","84251AZ007",,"AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","1","84251","AZ","Individual","No","06-6033492","84251AZ0070001","Aetna Advantage 5750 PD","84251AZ007",,"AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","1","84251","AZ","Individual","No","06-6033492","84251AZ0070001","Aetna Advantage 5750 PD","84251AZ007",,"AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","2","84251","AZ","Individual","No","06-6033492","84251AZ0070002","Aetna Advantage 6350","84251AZ007",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","2","84251","AZ","Individual","No","06-6033492","84251AZ0070002","Aetna Advantage 6350","84251AZ007",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","2","84251","AZ","Individual","No","06-6033492","84251AZ0070002","Aetna Advantage 6350","84251AZ007",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","4","84251","AZ","Individual","No","06-6033492","84251AZ0070004","Aetna AdvantagePlus 5500 PD","84251AZ007",,"AZN001","AZS001","AZF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","4","84251","AZ","Individual","No","06-6033492","84251AZ0070004","Aetna AdvantagePlus 5500 PD","84251AZ007",,"AZN001","AZS001","AZF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","6","84251","AZ","Individual","No","06-6033492","84251AZ0070009","Aetna Classic 5000","84251AZ007",,"AZN001","AZS001","AZF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070009-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","8","84251","AZ","Individual","No","06-6033492","84251AZ0070007","Aetna Premier 2000 PD","84251AZ007",,"AZN001","AZS001","AZF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","8","84251","AZ","Individual","No","06-6033492","84251AZ0070007","Aetna Premier 2000 PD","84251AZ007",,"AZN001","AZS001","AZF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","8","84251","AZ","Individual","No","06-6033492","84251AZ0070007","Aetna Premier 2000 PD","84251AZ007",,"AZN001","AZS001","AZF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","84251","HIOS","7","2013-09-17 16:07:07","9","84251","AZ","Individual","No","06-6033492","84251AZ0070005","Aetna Basic","84251AZ007",,"AZN001","AZS001","AZF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.996742362675517",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/az.html","84251AZ0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","No","59-1031071","86830AZ0040001","myCigna Health Savings 6100","86830AZ004","7730182962","AZN001","AZS001","AZF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services covered","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040001-00","Standard Bronze Off Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","1","86830","AZ","Individual","Yes","59-1031071","86830AZ0050001","myCigna Dental Pediatric","86830AZ005","7730182962","AZN001","AZS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"86830AZ0050001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-00","Standard Silver Off Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-01","Standard Silver On Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-03","Limited Cost Sharing Plan Variation","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-04","73% AV Level Silver Plan","72.50%","0.742465913295746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-05","87% AV Level Silver Plan","86.30%","0.867775917053223","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","3","86830","AZ","Individual","No","59-1031071","86830AZ0040005","myCigna Health Flex 1500","86830AZ004","7730182962","AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040005-06","94% AV Level Silver Plan","93.40%","0.93521922826767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","4","86830","AZ","Individual","No","59-1031071","86830AZ0040003","myCigna Health Flex 5100","86830AZ004","7730182962","AZN001","AZS001","AZF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040003-00","Standard Bronze Off Exchange Plan","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","4","86830","AZ","Individual","No","59-1031071","86830AZ0040003","myCigna Health Flex 5100","86830AZ004","7730182962","AZN001","AZS001","AZF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040003-01","Standard Bronze On Exchange Plan","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","4","86830","AZ","Individual","No","59-1031071","86830AZ0040003","myCigna Health Flex 5100","86830AZ004","7730182962","AZN001","AZS001","AZF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-00","Standard Silver Off Exchange Plan","70.40%","0.679997861385345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-01","Standard Silver On Exchange Plan","70.40%","0.679997861385345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-03","Limited Cost Sharing Plan Variation","70.40%","0.679997861385345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-04","73% AV Level Silver Plan","72.70%","0.721438705921173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,900","$5,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040007","myCigna Health Flex 3500","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-3500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040007-05","87% AV Level Silver Plan","86.10%","0.86097514629364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040009","myCigna Health Flex 1250","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040009-01","Standard Gold On Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040009","myCigna Health Flex 1250","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","AZ","86830","HIOS","12","2013-10-15 07:27:56","5","86830","AZ","Individual","No","59-1031071","86830AZ0040009","myCigna Health Flex 1250","86830AZ004","7730182962","AZN001","AZS001","AZF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/arizona-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/arizona-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","86830AZ0040009-03","Limited Cost Sharing Plan Variation","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010001","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010001-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010010","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010010-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010011","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010011-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010011","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010011-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010001","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010001-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010001","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010001","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010001-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010015","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010015-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010018","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010018-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"75"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010019","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010019-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"76"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010019","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010019-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"77"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"172"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"229"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010014","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"58"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010047","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS005","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010047-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010047","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS005","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010047-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010047","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS005","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010047","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS005","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010047-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010009","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010009-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010010","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010010-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010010","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010010-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010010","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"42"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010011","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"46"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010017","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010017-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"68"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"108"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010015","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010015-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010018","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010018-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"72"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010018","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010018-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"73"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010018","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"74"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010014","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010014-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010016","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010016-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"64"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010016","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010016-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"65"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010016","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"66"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010016","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010016-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010053","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS013","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010053-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010054","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS014","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010054-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010054","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS014","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010054-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010054","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS014","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010054-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"42"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010015","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010015","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010015-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010003","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010003-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010003","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010003-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010003","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010003","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010003-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010004","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010004-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010004","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010004-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010004","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-04","73% AV Level Silver Plan","72.40%","0.729091167449951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-05","87% AV Level Silver Plan","87.20%","0.872214913368225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$50","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-06","94% AV Level Silver Plan","94.90%","0.948510587215424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010004","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS006","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010004-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010005","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010005-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010005","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010005-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010005","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010005","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS007","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010005-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010006","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010006-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010006","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010006-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010006","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010006","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010006-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010014","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010014-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010014","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS005","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010014-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010007","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010007-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010007","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010007-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010007","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"30"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010007","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS011","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010007-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010008","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010008-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010008","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010008-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010008","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010008","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010008-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010009","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010009-00","Standard Gold Off Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010009","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010009-01","Standard Gold On Exchange Plan","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010009","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"38"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010017","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010017-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"69"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010017","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"70"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010017","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS008","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010017-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"71"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010019","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010019-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"78"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010011","Gold Canyon 575","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010011-03","Limited Cost Sharing Plan Variation","81.82%","0.818177342414856","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$575","$1,150","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"47"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010012","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"50"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010012","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS002","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010012-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"193"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"194"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"195"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"196"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080010-01","Standard Bronze On Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010048","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS006","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010048-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080005-00","Standard Gold Off Exchange Plan","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080005-01","Standard Gold On Exchange Plan","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"118"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"145"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"146"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"147"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"148"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"155"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"156"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"157"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"158"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"159"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"160"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010032","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010032-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"161"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"162"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"119"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"197"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"198"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010019","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS012","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010019-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"79"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010020","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010020-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"80"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010020","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010020-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"81"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010020","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"82"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"123"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"124"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"125"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"126"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"127"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"128"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"129"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"130"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"189"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"190"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"191"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010037","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"192"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010020","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS013","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010020-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"83"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010021","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010021-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"84"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010021","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010021-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"85"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010021","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"86"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010021","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS014","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010021-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"87"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010022","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010022-00","Standard Gold Off Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"88"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010022","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010022-01","Standard Gold On Exchange Plan","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"89"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010022","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"90"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010022","Gold Canyon 1050","88925AZ001","7356344581","AZN001","AZS015","AZF001","New","HMO","Gold","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$1,000","1","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010022-03","Limited Cost Sharing Plan Variation","78.15%","0.781552314758301","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$2,100","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"91"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"92"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"93"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"94"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"95"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"96"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"97"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010023","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010023-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"98"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"106"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"171"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"230"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"143"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"144"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"210"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"211"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"212"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"213"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"214"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"215"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010052","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS012","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010052-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010052","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS012","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010052-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010053","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS013","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"38"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"174"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"175"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"183"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"184"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"236"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"237"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"238"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"239"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"240"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010045","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS002","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010045-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010045","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS002","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010045-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010045","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS002","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010045-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010045","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS002","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010045-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","3","88925","AZ","Individual","No","45-4370907","88925AZ0010056","Copper Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF004","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,"$6,350","0","3","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010056-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010054","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS014","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010054-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"109"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"110"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"111"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010025","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010025-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"112"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"113"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"114"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"115"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"116"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010026","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS006","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010026-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"117"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"120"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"121"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010027","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"122"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"131"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"132"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010028","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","34.08","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010028-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"133"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"134"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"135"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"136"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"137"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"138"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"139"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010029","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","30.16","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010029-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"140"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-00","Standard Silver Off Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"141"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010030","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","35.86","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010030-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"142"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"149"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"150"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"151"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"152"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"153"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010031","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.35","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010031-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"154"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-01","Standard Silver On Exchange Plan","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"163"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"164"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-03","Limited Cost Sharing Plan Variation","71.98%","0.719941437244415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,575","$3,150","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"165"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"166"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"167"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010033","Silver Canyon 1575","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","33.51","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010033-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"168"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"169"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"170"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"224"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"225"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"226"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"227"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"228"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010042","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS013","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010042-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"231"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"232"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"233"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010034","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS002","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010034-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"173"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090011","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$5000","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0090011-01","Standard Bronze On Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-05","87% AV Level Silver Plan","87.29%","0.876164734363556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-06","94% AV Level Silver Plan","95.00%","0.949264228343964","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080010-00","Standard Bronze Off Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080005-03","Limited Cost Sharing Plan Variation","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080006-00","Standard Gold Off Exchange Plan","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080006-01","Standard Gold On Exchange Plan","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080006-03","Limited Cost Sharing Plan Variation","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-00","Standard Silver Off Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0090007-00","Standard Silver Off Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"185"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"186"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"187"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010036","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS005","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010036-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"188"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"199"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"200"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"241"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"242"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"243"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"244"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010044","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS015","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.21","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010044-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"245"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"201"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"202"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010038","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS007","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010038-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"203"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"204"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"205"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"206"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"207"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"208"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010039","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS008","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","43.95","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010039-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"209"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"216"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010040","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS011","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","38.89","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010040-06","94% AV Level Silver Plan","95.00%","0.949697554111481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"217"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-00","Standard Silver Off Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"218"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-01","Standard Silver On Exchange Plan","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"219"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"220"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"221"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-04","73% AV Level Silver Plan","74.00%","0.740313351154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"222"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010041","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS012","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010041-05","87% AV Level Silver Plan","87.91%","0.879096865653992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"223"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"234"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","1","88925","AZ","Individual","No","45-4370907","88925AZ0010043","Silver Canyon 2375","88925AZ001","7356344581","AZN001","AZS014","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","46.24","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$2,000","5","5","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010043-03","Limited Cost Sharing Plan Variation","68.07%","0.681194365024567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,375","$4,750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"235"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010055","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS015","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010055-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010055","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS015","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010055-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010055","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS015","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010055-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"46"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010055","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS015","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010055-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"47"
"2014","AZ","90264","HIOS","2","2013-07-01 08:34:30","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0040002","EHB High PPO","90264AZ004",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.96",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"90264AZ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","90264","HIOS","2","2013-07-01 08:34:30","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0040001","EHB Low PPO","90264AZ004",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"90264AZ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","90264","HIOS","2","2013-07-01 08:34:30","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0030002","EHB High Passive","90264AZ003",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.08",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"90264AZ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ009",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0090015-01","Standard Platinum On Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf","www.healthnet.com/drugs","91450AZ0090016-00","Standard Gold Off Exchange Plan","78.20%","0.793012678623199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080014-03","Limited Cost Sharing Plan Variation","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf","www.healthnet.com/drugs","91450AZ0090016-01","Standard Gold On Exchange Plan","78.20%","0.793012678623199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf","www.healthnet.com/drugs","91450AZ0090017-00","Standard Gold Off Exchange Plan","79.60%","0.807668209075928","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080015-00","Standard Platinum Off Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080015-01","Standard Platinum On Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","3","88925","AZ","Individual","No","45-4370907","88925AZ0010056","Copper Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF004","New","HMO","Catastrophic","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,"$6,350","0","3","0","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010056-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-04","73% AV Level Silver Plan","72.80%","0.727959990501404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0090007-01","Standard Silver On Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-01","Standard Silver On Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090008-00","Standard Silver Off Exchange Plan","70.40%","0.710852086544037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090008-01","Standard Silver On Exchange Plan","70.40%","0.710852086544037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-03","Limited Cost Sharing Plan Variation","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-04","73% AV Level Silver Plan","72.40%","0.729091167449951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-05","87% AV Level Silver Plan","87.20%","0.872214913368225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$50","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010048","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS006","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010048-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010048","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS006","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080004-00","Standard Gold Off Exchange Plan","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080004-01","Standard Gold On Exchange Plan","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080004-03","Limited Cost Sharing Plan Variation","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-01","Standard Silver On Exchange Plan","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-03","Limited Cost Sharing Plan Variation","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090009-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090009-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010048","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS006","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010048-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010049","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS007","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010049-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010049","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS007","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010049-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010049","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS007","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010049-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010049","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS007","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010049-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010050","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS008","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010050-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010050","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS008","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010050-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010050","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS008","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010050-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010050","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS008","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010050-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010051","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010051-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010051","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010051-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010051","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010051-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"30"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010051","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS011","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010051-03","Limited Cost Sharing Plan Variation","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010052","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS012","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010052-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010052","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS012","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010052-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010053","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS013","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010053-00","Standard Bronze Off Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","AZ","88925","HIOS","5","2014-01-17 09:36:20","2","88925","AZ","Individual","No","45-4370907","88925AZ0010053","Bronze Canyon","88925AZ001","7356344581","AZN001","AZS013","AZF003","New","HMO","Bronze","Yes","Both","Yes","Yes","Dermatologist, Pain Management/Anesthesiologist, Plastic Surgeon, Podiatrist, Psychiatrist/Psychologist","See Evidence of Coverage","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$6,350","0","0","1","2014-01-01",,"No",,"Yes","Contracted providers only, except in emergencies.","No","http://uamarketplace.com/MemberResourcePage.aspx","http://join.uamarketplace.com/UAHP/Application/FFMInitialPayment","www.uamarketplace.com","http://uamarketplace.com/MemberResourcePage.aspx","88925AZ0010053-01","Standard Bronze On Exchange Plan","59.02%","0.582327246665955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","AZ","90264","HIOS","2","2013-07-01 08:34:30","1","90264","AZ","SHOP (Small Group)","Yes","47-0098400","90264AZ0030001","EHB Low Passive","90264AZ003",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"90264AZ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080001-00","Standard Platinum Off Exchange Plan","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ009",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090001-00","Standard Platinum Off Exchange Plan","88.50%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ009",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090001-01","Standard Platinum On Exchange Plan","88.50%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080001-01","Standard Platinum On Exchange Plan","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090002-00","Standard Platinum Off Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080001","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080001-03","Limited Cost Sharing Plan Variation","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090002-01","Standard Platinum On Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080002-00","Standard Platinum Off Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ009",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0090003-00","Standard Platinum Off Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080002-01","Standard Platinum On Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ009",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0090003-01","Standard Platinum On Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf","www.healthnet.com/drugs","91450AZ0090004-00","Standard Gold Off Exchange Plan","78.20%","0.793012678623199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080002","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080002-03","Limited Cost Sharing Plan Variation","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090004","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ009",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_500_shop.pdf","www.healthnet.com/drugs","91450AZ0090004-01","Standard Gold On Exchange Plan","78.20%","0.793012678623199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080003-00","Standard Platinum Off Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf","www.healthnet.com/drugs","91450AZ0090005-00","Standard Gold Off Exchange Plan","79.60%","0.807668209075928","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090005","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf","www.healthnet.com/drugs","91450AZ0090005-01","Standard Gold On Exchange Plan","79.60%","0.807668209075928","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080003-01","Standard Platinum On Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf","www.healthnet.com/drugs","91450AZ0090006-00","Standard Gold Off Exchange Plan","80.90%","0.817930400371552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090006","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf","www.healthnet.com/drugs","91450AZ0090006-01","Standard Gold On Exchange Plan","80.90%","0.817930400371552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","1","91450","AZ","Individual","No","36-3097810","91450AZ0080003","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080003-03","Limited Cost Sharing Plan Variation","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080007","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080007-06","94% AV Level Silver Plan","94.90%","0.948510587215424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","2","91450","AZ","Individual","No","36-3097810","91450AZ0080008","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080008-00","Standard Silver Off Exchange Plan","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0090010-00","Standard Bronze Off Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0090010-01","Standard Bronze On Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080009","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080009-03","Limited Cost Sharing Plan Variation","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090011","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$5000","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0090011-00","Standard Bronze Off Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080010","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080010-03","Limited Cost Sharing Plan Variation","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080011","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080011-00","Standard Bronze Off Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080011","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080011-01","Standard Bronze On Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080011","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080011","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080011-03","Limited Cost Sharing Plan Variation","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080012","Health Net CommunityCare HMO Open Access Basic 0%/0%/$6350","91450AZ008",,"AZN001","AZS001","AZF011","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","3","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_iex.pdf","www.healthnet.com/drugs","91450AZ0080012-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"19"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","3","91450","AZ","Individual","No","36-3097810","91450AZ0080012","Health Net CommunityCare HMO Open Access Basic 0%/0%/$6350","91450AZ008",,"AZN001","AZS001","AZF011","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","3","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_ped_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_iex.pdf","www.healthnet.com/drugs","91450AZ0080012-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"20"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080013-00","Standard Platinum Off Exchange Plan","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ009",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090013-00","Standard Platinum Off Exchange Plan","88.50%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080013-01","Standard Platinum On Exchange Plan","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ009",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090013-01","Standard Platinum On Exchange Plan","88.50%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090014-00","Standard Platinum Off Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_15_30_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0090014-01","Standard Platinum On Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080013","Health Net CommunityCare HMO Open Access Platinum $15/$30/$3000","91450AZ008",,"AZN001","AZS001","AZF001","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_15_30_3000_iex.pdf","www.healthnet.com/drugs","91450AZ0080013-03","Limited Cost Sharing Plan Variation","88.30%","0.882889747619629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ009",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_platinum_20_40_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0090015-00","Standard Platinum Off Exchange Plan","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080014-00","Standard Platinum Off Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080014","Health Net CommunityCare HMO Open Access Platinum $20/$40/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080014-01","Standard Platinum On Exchange Plan","88.40%","0.884117066860199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_30_60_6000_750_shop.pdf","www.healthnet.com/drugs","91450AZ0090017-01","Standard Gold On Exchange Plan","79.60%","0.807668209075928","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf","www.healthnet.com/drugs","91450AZ0090018-00","Standard Gold Off Exchange Plan","80.90%","0.817930400371552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080015","Health Net CommunityCare HMO Open Access Platinum $20/$40/$4000","91450AZ008",,"AZN001","AZS001","AZF003","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_platinum_20_40_4000_iex.pdf","www.healthnet.com/drugs","91450AZ0080015-03","Limited Cost Sharing Plan Variation","89.10%","0.891058802604675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ009",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_gold_25_50_5000_600_shop.pdf","www.healthnet.com/drugs","91450AZ0090018-01","Standard Gold On Exchange Plan","80.90%","0.817930400371552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080016-00","Standard Gold Off Exchange Plan","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080016-01","Standard Gold On Exchange Plan","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080016","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$500","91450AZ008",,"AZN001","AZS001","AZF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_500_iex.pdf","www.healthnet.com/drugs","91450AZ0080016-03","Limited Cost Sharing Plan Variation","78.20%","0.782358944416046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080017-00","Standard Gold Off Exchange Plan","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080017-01","Standard Gold On Exchange Plan","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080017","Health Net CommunityCare HMO Open Access Gold $30/$60/$6000/$750","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"3","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_30_60_6000_750_iex.pdf","www.healthnet.com/drugs","91450AZ0080017-03","Limited Cost Sharing Plan Variation","79.60%","0.795998930931091","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080018-00","Standard Gold Off Exchange Plan","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080018-01","Standard Gold On Exchange Plan","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","4","91450","AZ","Individual","No","36-3097810","91450AZ0080018","Health Net CommunityCare HMO Open Access Gold $25/$50/$5000/$600","91450AZ008",,"AZN001","AZS001","AZF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_gold_25_50_5000_600_iex.pdf","www.healthnet.com/drugs","91450AZ0080018-03","Limited Cost Sharing Plan Variation","80.90%","0.80855917930603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-00","Standard Silver Off Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0090019-00","Standard Silver Off Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-01","Standard Silver On Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_45_65_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0090019-01","Standard Silver On Exchange Plan","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090020-00","Standard Silver Off Exchange Plan","70.40%","0.715014636516571","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-03","Limited Cost Sharing Plan Variation","69.70%","0.697469711303711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ009",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_silver_30_50_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090020-01","Standard Silver On Exchange Plan","70.40%","0.715014636516571","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-04","73% AV Level Silver Plan","72.40%","0.729091167449951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-05","87% AV Level Silver Plan","87.20%","0.872214913368225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$50","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080019","Health Net CommunityCare HMO Open Access Silver $45/$65/$1500","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_45_65_1500_iex.pdf","www.healthnet.com/drugs","91450AZ0080019-06","94% AV Level Silver Plan","94.90%","0.948510587215424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-00","Standard Silver Off Exchange Plan","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-01","Standard Silver On Exchange Plan","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-03","Limited Cost Sharing Plan Variation","70.40%","0.704474925994873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-04","73% AV Level Silver Plan","72.40%","0.729091167449951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-05","87% AV Level Silver Plan","87.20%","0.872214913368225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$50","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","5","91450","AZ","Individual","No","36-3097810","91450AZ0080020","Health Net CommunityCare HMO Open Access Silver $30/$50/$2000","91450AZ008",,"AZN001","AZS001","AZF006","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_silver_30_50_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080020-06","94% AV Level Silver Plan","94.90%","0.948510587215424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090021-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ009",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_silver_20_20_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0090021-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0090022-00","Standard Bronze Off Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-03","Limited Cost Sharing Plan Variation","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0090022-01","Standard Bronze On Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090023","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$5000","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0090023-00","Standard Bronze Off Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-04","73% AV Level Silver Plan","72.80%","0.727959990501404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-05","87% AV Level Silver Plan","87.29%","0.876164734363556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0090023","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$5000","91450AZ009",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_cc_hmo_hsa_bronze_40_40_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0090023-01","Standard Bronze On Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080021","Health Net CommunityCare HSA Open Access Silver 20%/20%/$2000","91450AZ008",,"AZN001","AZS001","AZF002","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_silver_20_20_2000_iex.pdf","www.healthnet.com/drugs","91450AZ0080021-06","94% AV Level Silver Plan","95.00%","0.949264228343964","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080022-00","Standard Bronze Off Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080022-01","Standard Bronze On Exchange Plan","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080022","Health Net CommunityCare HSA Open Access Bronze  40%/40%/$3500","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_3500_iex.pdf","www.healthnet.com/drugs","91450AZ0080022-03","Limited Cost Sharing Plan Variation","61.80%","0.618339836597443","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080023","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080023-00","Standard Bronze Off Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080023","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080023-01","Standard Bronze On Exchange Plan","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080023","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080023","Health Net CommunityCare HSA  Open Access Bronze  40%/40%/$5000","91450AZ008",,"AZN001","AZS001","AZF010","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_hsa_bronze_40_40_5000_iex.pdf","www.healthnet.com/drugs","91450AZ0080023-03","Limited Cost Sharing Plan Variation","60.10%","0.600753843784332","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080024","Health Net CommunityCare HMO Open Access Basic 0%/0%/$6350","91450AZ008",,"AZN001","AZS001","AZF011","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","3","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_iex.pdf","www.healthnet.com/drugs","91450AZ0080024-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"19"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","6","91450","AZ","Individual","No","36-3097810","91450AZ0080024","Health Net CommunityCare HMO Open Access Basic 0%/0%/$6350","91450AZ008",,"AZN001","AZS001","AZF011","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Pregnancy",,"0.996",,,"0","3","0","2014-01-01",,"No",,"Yes","Emergent services covered","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_sbc_iex.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/ifp/az_ifp_cc_hmo_basic_0_0_6350_iex.pdf","www.healthnet.com/drugs","91450AZ0080024-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"20"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160001","Health Net Open Access HMO Platinum $15/$30/$350","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0160001-00","Standard Platinum Off Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160001","Health Net Open Access HMO Platinum $15/$30/$350","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0160001-01","Standard Platinum On Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160002","Health Net Open Access HMO Platinum $15/$30/$500","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0160002-00","Standard Platinum Off Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160002","Health Net Open Access HMO Platinum $15/$30/$500","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0160002-01","Standard Platinum On Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160003","Health Net Open Access HMO Platinum $15/$30/$750","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0160003-00","Standard Platinum Off Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160003","Health Net Open Access HMO Platinum $15/$30/$750","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0160003-01","Standard Platinum On Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160004","Health Net  Open Access HMO Gold $20/$40/$500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0160004-00","Standard Gold Off Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160004","Health Net  Open Access HMO Gold $20/$40/$500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0160004-01","Standard Gold On Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160005","Health Net  Open Access HMO Gold $20/$40/$1000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0160005-00","Standard Gold Off Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160005","Health Net  Open Access HMO Gold $20/$40/$1000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0160005-01","Standard Gold On Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160006","Health Net  Open Access HMO Gold $20/$40/$2000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0160006-00","Standard Gold Off Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","7","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160006","Health Net  Open Access HMO Gold $20/$40/$2000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0160006-01","Standard Gold On Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160007","Health Net  Open Access HMO Silver $30/$50/$2000/$5000","91450AZ016",,"AZN002","AZS002","AZF013","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0160007-00","Standard Silver Off Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160007","Health Net  Open Access HMO Silver $30/$50/$2000/$5000","91450AZ016",,"AZN002","AZS002","AZF013","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0160007-01","Standard Silver On Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160008","Health Net Open Access HMO Silver $30/$50/$1500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160008-00","Standard Silver Off Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160008","Health Net Open Access HMO Silver $30/$50/$1500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160008-01","Standard Silver On Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160009","Health Net Open Access HMO Silver $30/$50/$2000/$6350","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160009-00","Standard Silver Off Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","8","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160009","Health Net Open Access HMO Silver $30/$50/$2000/$6350","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160009-01","Standard Silver On Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160010","Health Net Open Access HMO Platinum $15/$30/$350","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0160010-00","Standard Platinum Off Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160010","Health Net Open Access HMO Platinum $15/$30/$350","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_350_2000_shop.pdf","www.healthnet.com/drugs","91450AZ0160010-01","Standard Platinum On Exchange Plan","88.20%","0.88204163312912","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160011","Health Net Open Access HMO Platinum $15/$30/$500","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0160011-00","Standard Platinum Off Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160011","Health Net Open Access HMO Platinum $15/$30/$500","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0160011-01","Standard Platinum On Exchange Plan","88.70%","0.892422080039978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160012","Health Net Open Access HMO Platinum $15/$30/$750","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0160012-00","Standard Platinum Off Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160012","Health Net Open Access HMO Platinum $15/$30/$750","91450AZ016",,"AZN002","AZS002","AZF012","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0160012-01","Standard Platinum On Exchange Plan","89.60%","0.89629739522934","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160013","Health Net  Open Access HMO Gold $20/$40/$500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0160013-00","Standard Gold Off Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160013","Health Net  Open Access HMO Gold $20/$40/$500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_500_3000_shop.pdf","www.healthnet.com/drugs","91450AZ0160013-01","Standard Gold On Exchange Plan","81.60%","0.816055238246918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160014","Health Net  Open Access HMO Gold $20/$40/$1000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0160014-00","Standard Gold Off Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160014","Health Net  Open Access HMO Gold $20/$40/$1000","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0160014-01","Standard Gold On Exchange Plan","78.90%","0.788787484169006","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160015","Health Net  Open Access HMO Gold $20/$40/$2000","91450AZ016",,"AZN002","AZS001","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0160015-00","Standard Gold Off Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","9","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160015","Health Net  Open Access HMO Gold $20/$40/$2000","91450AZ016",,"AZN002","AZS001","AZF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0160015-01","Standard Gold On Exchange Plan","78.50%","0.784225404262543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160016","Health Net  Open Access HMO Silver $30/$50/$2000/$5000","91450AZ016",,"AZN002","AZS002","AZF013","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0160016-00","Standard Silver Off Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160016","Health Net  Open Access HMO Silver $30/$50/$2000/$5000","91450AZ016",,"AZN002","AZS002","AZF013","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0160016-01","Standard Silver On Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160017","Health Net Open Access HMO Silver $30/$50/$1500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160017-00","Standard Silver Off Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160017","Health Net Open Access HMO Silver $30/$50/$1500","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160017-01","Standard Silver On Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160018","Health Net Open Access HMO Silver $30/$50/$2000/$6350","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160018-00","Standard Silver Off Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","10","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0160018","Health Net Open Access HMO Silver $30/$50/$2000/$6350","91450AZ016",,"AZN002","AZS002","AZF006","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_HMO_OA_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0160018-01","Standard Silver On Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170001","Health Net ExcelCare Platinum $15/$30/$500","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0170001-00","Standard Platinum Off Exchange Plan","88.20%","0.886870384216309","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170001","Health Net ExcelCare Platinum $15/$30/$500","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0170001-01","Standard Platinum On Exchange Plan","88.20%","0.886870384216309","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170002","Health Net ExcelCare Platinum $15/$30/$750","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0170002-00","Standard Platinum Off Exchange Plan","89.60%","0.89629727602005","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170002","Health Net ExcelCare Platinum $15/$30/$750","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0170002-01","Standard Platinum On Exchange Plan","89.60%","0.89629727602005","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170003","Health Net ExcelCare Gold $20/$40/$1000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0170003-00","Standard Gold Off Exchange Plan","78.90%","0.789303421974182","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170003","Health Net ExcelCare Gold $20/$40/$1000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0170003-01","Standard Gold On Exchange Plan","78.90%","0.789303421974182","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170004","Health Net ExcelCare  Gold $20/$40/$2000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0170004-00","Standard Gold Off Exchange Plan","78.50%","0.784717559814453","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","11","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170004","Health Net ExcelCare  Gold $20/$40/$2000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0170004-01","Standard Gold On Exchange Plan","78.50%","0.784717559814453","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170005","Health Net ExcelCare Silver $30/$50/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF013","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170005-00","Standard Silver Off Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170005","Health Net ExcelCare Silver $30/$50/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF013","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170005-01","Standard Silver On Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170006","Health Net ExcelCare Silver $30/$50/$1500","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170006-00","Standard Silver Off Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170006","Health Net ExcelCare Silver $30/$50/$1500","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170006-01","Standard Silver On Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170007","Health Net ExcelCare Silver $30/$50/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170007-00","Standard Silver Off Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","12","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170007","Health Net ExcelCare Silver $30/$50/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170007-01","Standard Silver On Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170008","Health Net ExcelCare HSA Silver 30%/30%/$2000","91450AZ017",,"AZN003","AZS003","AZF007","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170008-00","Standard Silver Off Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170008","Health Net ExcelCare HSA Silver 30%/30%/$2000","91450AZ017",,"AZN003","AZS003","AZF007","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170008-01","Standard Silver On Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170009","Health Net ExcelCare HSA Silver 20%/20%/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170009-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170009","Health Net ExcelCare HSA Silver 20%/20%/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170009-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170010","Health Net ExcelCare HSA Silver 20%/20%/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170010-00","Standard Silver Off Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","13","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170010","Health Net ExcelCare HSA Silver 20%/20%/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_ped_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170010-01","Standard Silver On Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170011","Health Net ExcelCare Platinum $15/$30/$500","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0170011-00","Standard Platinum Off Exchange Plan","88.20%","0.886870384216309","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170011","Health Net ExcelCare Platinum $15/$30/$500","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_500_1500_shop.pdf","www.healthnet.com/drugs","91450AZ0170011-01","Standard Platinum On Exchange Plan","88.20%","0.886870384216309","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070072","BlueOptions Predictable Cost 1413","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070072-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010001","BlueOptions Essential Health S1400","16842FL001",,"FLN001","FLS001","FLF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","www.bcbsfl.com/DocumentLibrary/SBC/2014/S1400.pdf","www.floridablue.com/shopmarketplacethankyou","www.bcbsfl.com/DocumentLibrary/MiniSummary/2014/S1400.pdf","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0010001-01","Standard Silver On Exchange Plan","69.70%","0.696754574775696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","SHOP (Small Group)","No","59-2015694","16842FL0010002","BlueOptions Essential Health S1401","16842FL001",,"FLN001","FLS001","FLF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","www.bcbsfl.com/DocumentLibrary/SBC/2014/S1401.pdf","www.floridablue.com/shopmarketplacethankyou","www.bcbsfl.com/DocumentLibrary/MiniSummary/2014/S1401.pdf","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0010002-01","Standard Gold On Exchange Plan","78.20%","0.782234013080597","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070072","BlueOptions Predictable Cost 1413","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070072-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070072","BlueOptions Predictable Cost 1413","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070072-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070072","BlueOptions Predictable Cost 1413","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070072-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-00","Standard Silver Off Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$11,000","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$8,600","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0100001","Smile for Health Child C60A60","99180AZ010",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a60-ppo.pdf",,,,"99180AZ0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0140001","Meritus Smart Choice Gold","92045AZ014",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982135056512853",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0140001-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0140001","Meritus Smart Choice Gold","92045AZ014",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982135056512853",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0140001-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0190001","Meritus Gold Smart Choice","92045AZ019",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982942175821105",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0190001-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170012","Health Net ExcelCare Platinum $15/$30/$750","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0170012-00","Standard Platinum Off Exchange Plan","89.60%","0.89629727602005","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-06","94% AV Level Silver Plan","93.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0190001","Meritus Gold Smart Choice","92045AZ019",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982942175821105",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0190001-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0200001","Meritus Silver Affordable Choice","92045AZ020",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978887059473411",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0200001-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-03","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$8,600","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-00","Standard Silver Off Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$11,000","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0210001","Meritus Silver Reliable","92045AZ021",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0210001-00","Standard Silver Off Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$11,000","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$11,000","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0210001","Meritus Silver Reliable","92045AZ021",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0210001-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$11,000","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-00","Standard Silver Off Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-01","Standard Silver On Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-03","Limited Cost Sharing Plan Variation","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-04","73% AV Level Silver Plan","73.56%","0.735637664794922","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170012","Health Net ExcelCare Platinum $15/$30/$750","91450AZ017",,"AZN003","AZS003","AZF012","New","HMO","Platinum","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_platinum_15_30_750_1000_shop.pdf","www.healthnet.com/drugs","91450AZ0170012-01","Standard Platinum On Exchange Plan","89.60%","0.89629727602005","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170013","Health Net ExcelCare Gold $20/$40/$1000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0170013-00","Standard Gold Off Exchange Plan","78.90%","0.789303421974182","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170013","Health Net ExcelCare Gold $20/$40/$1000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_1000_4000_shop.pdf","www.healthnet.com/drugs","91450AZ0170013-01","Standard Gold On Exchange Plan","78.90%","0.789303421974182","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0220001","Meritus Silver Secure","92045AZ022",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979788922161389",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0220001-00","Standard Silver Off Exchange Plan","68.73%","0.687288999557495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0140001","Meritus Smart Choice Gold","92045AZ014",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982135056512853",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","Individual","Yes","86-0307623","99180AZ0010001","Smile for Health Child C60A70","99180AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0150002","Smile for Health Family C80A80","99180AZ015",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c80a80-ppo.pdf",,,,"99180AZ0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","2","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0030001","Guardian Family Advantage Plus","15833FL003",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0030001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0050001","Guardian Family Essentials Plus","15833FL005",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0050001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","3","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0050001","Guardian Family Essentials Plus","15833FL005",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0050001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120034","BlueSelect Predictable Cost Plus 1446P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120034-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120034","BlueSelect Predictable Cost Plus 1446P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0140001","Meritus Smart Choice Gold","92045AZ014",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.982135056512853",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0140001-03","Limited Cost Sharing Plan Variation","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0220001","Meritus Silver Secure","92045AZ022",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979788922161389",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0220001-01","Standard Silver On Exchange Plan","68.73%","0.687288999557495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120034","BlueSelect Predictable Cost Plus 1446P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120034-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential (HSA) 1419","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070084-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170014","Health Net ExcelCare  Gold $20/$40/$2000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0170014-00","Standard Gold Off Exchange Plan","78.50%","0.784717559814453","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","14","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170014","Health Net ExcelCare  Gold $20/$40/$2000","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Gold","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_gold_20_40_2000_3500_shop.pdf","www.healthnet.com/drugs","91450AZ0170014-01","Standard Gold On Exchange Plan","78.50%","0.784717559814453","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170015","Health Net ExcelCare Silver $30/$50/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF013","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170015-00","Standard Silver Off Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170015","Health Net ExcelCare Silver $30/$50/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF013","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170015-01","Standard Silver On Exchange Plan","72.00%","0.71975713968277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170016","Health Net ExcelCare Silver $30/$50/$1500","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170016-00","Standard Silver Off Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170016","Health Net ExcelCare Silver $30/$50/$1500","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_1500_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170016-01","Standard Silver On Exchange Plan","71.40%","0.713577926158905","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170017","Health Net ExcelCare Silver $30/$50/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170017-00","Standard Silver Off Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","15","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170017","Health Net ExcelCare Silver $30/$50/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF006","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_silver_30_50_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170017-01","Standard Silver On Exchange Plan","70.40%","0.703834652900696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170018","Health Net ExcelCare HSA Silver 30%/30%/$2000","91450AZ017",,"AZN003","AZS003","AZF007","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170018-00","Standard Silver Off Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170018","Health Net ExcelCare HSA Silver 30%/30%/$2000","91450AZ017",,"AZN003","AZS003","AZF007","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_30_30_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170018-01","Standard Silver On Exchange Plan","68.90%","0.688884735107422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170019","Health Net ExcelCare HSA Silver 20%/20%/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170019-00","Standard Silver Off Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170019","Health Net ExcelCare HSA Silver 20%/20%/$2000/$6350","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_6350_shop.pdf","www.healthnet.com/drugs","91450AZ0170019-01","Standard Silver On Exchange Plan","68.70%","0.687518894672394","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170020","Health Net ExcelCare HSA Silver 20%/20%/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170020-00","Standard Silver Off Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","91450","HIOS","9","2014-01-21 08:29:49","16","91450","AZ","SHOP (Small Group)","No","36-3097810","91450AZ0170020","Health Net ExcelCare HSA Silver 20%/20%/$2000/$5000","91450AZ017",,"AZN003","AZS003","AZF002","New","HMO","Silver","Yes","Both","Yes","Yes","A referral is necessary for any specialist except an OBGYN.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.996",,,"0","0","0","2014-01-01",,"No",,"No","Emergent services covered.","No","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_sbc_shop.pdf","https://www.healthnet.com/exchange/az","https://www.healthnet.com/static/general/unprotected/pdfs/az/sbg/az_sbg_EC_HSA_silver_20_20_2000_5000_shop.pdf","www.healthnet.com/drugs","91450AZ0170020-01","Standard Silver On Exchange Plan","70.00%","0.69994056224823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","Individual","No","27-3835905","92045AZ0030001","Meritus Healthy Gold","92045AZ003",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.982287405287812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0030001-00","Standard Gold Off Exchange Plan","81.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0170001","Meritus Gold Healthy Choice","92045AZ017",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.983096574200986",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0170001-00","Standard Gold Off Exchange Plan","81.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","Individual","No","27-3835905","92045AZ0030001","Meritus Healthy Gold","92045AZ003",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.982287405287812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0030001-01","Standard Gold On Exchange Plan","81.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0170001","Meritus Gold Healthy Choice","92045AZ017",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.983096574200986",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0170001-01","Standard Gold On Exchange Plan","81.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","Individual","No","27-3835905","92045AZ0030001","Meritus Healthy Gold","92045AZ003",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.982287405287812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","1","92045","AZ","Individual","No","27-3835905","92045AZ0030001","Meritus Healthy Gold","92045AZ003",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.982287405287812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0030001-03","Limited Cost Sharing Plan Variation","81.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","Individual","No","27-3835905","92045AZ0130001","Meritus Clear Choice Gold","92045AZ013",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0130001-00","Standard Gold Off Exchange Plan","79.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0180001","Meritus Gold Clear Choice","92045AZ018",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0180001-00","Standard Gold Off Exchange Plan","79.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","Individual","No","27-3835905","92045AZ0130001","Meritus Clear Choice Gold","92045AZ013",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0130001-01","Standard Gold On Exchange Plan","79.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0180001","Meritus Gold Clear Choice","92045AZ018",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0180001-01","Standard Gold On Exchange Plan","79.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","Individual","No","27-3835905","92045AZ0130001","Meritus Clear Choice Gold","92045AZ013",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0130001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","2","92045","AZ","Individual","No","27-3835905","92045AZ0130001","Meritus Clear Choice Gold","92045AZ013",,"AZN001","AZS001","AZF003","New","PPO","Gold","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0130001-03","Limited Cost Sharing Plan Variation","79.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0200001","Meritus Silver Affordable Choice","92045AZ020",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978887059473411",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0200001-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","3","92045","AZ","Individual","No","27-3835905","92045AZ0250001","Meritus Affordable Silver","92045AZ025",,"AZN001","AZS001","AZF004","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$32.56","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977915987543625",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0250001-06","94% AV Level Silver Plan","93.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","4","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0060001","Guardian Family Essentials","15833FL006",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0060001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","5","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0080001","Managed DentalGuard FL Child Essentials 1","15833FL008",,"FLN001","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0080001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","5","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0080001","Managed DentalGuard FL Child Essentials 1","15833FL008",,"FLN001","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0080001-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","5","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0070001","Managed DentalGuard FL Child Essentials 2","15833FL007",,"FLN001","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0070001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","5","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0070001","Managed DentalGuard FL Child Essentials 2","15833FL007",,"FLN001","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0070001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","6","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0090001","Managed DentalGuard FL10 Family Plan","15833FL009",,"FLN001","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0090001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120032","BlueSelect Predictable Cost 1446","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120032-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-00","Standard Silver Off Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","Individual","Yes","86-0307623","99180AZ0040002","Smile For Health Family C60A50","99180AZ004",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0100001","Smile for Health Child C60A60","99180AZ010",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a60-ppo.pdf",,,,"99180AZ0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","6","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0090001","Managed DentalGuard FL10 Family Plan","15833FL009",,"FLN001","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0090001-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","6","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0100001","Managed DentalGuard FL20 Family Plan","15833FL010",,"FLN001","FLS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0100001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","6","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0110001","Managed DentalGuard FL30 Family Plan","15833FL011",,"FLN001","FLS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0110001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","15980","HIOS","5","2014-01-16 07:24:04","1","15980","FL","Individual","Yes","39-1263473","15980FL0160001","Humana Dental Smart Choice","15980FL016",,"FLN001","FLS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"15980FL0160001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","4","92045","AZ","Individual","No","27-3835905","92045AZ0160001","Meritus Reliable Silver","92045AZ016",,"AZN001","AZS001","AZF003","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.89","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0160001-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-05","87% AV Level Silver Plan","87.75%","0.877534210681915","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0070073","BlueOptions Predictable Cost 1423","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070073-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120032","BlueSelect Predictable Cost 1446","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120032-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120032","BlueSelect Predictable Cost 1446","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120032-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120032","BlueSelect Predictable Cost 1446","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120047","BlueSelect Essential (HSA) 1463","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"40"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120047","BlueSelect Essential (HSA) 1463","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120047-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","5","92045","AZ","Individual","No","27-3835905","92045AZ0090001","Meritus Secure Silver","92045AZ009",,"AZN001","AZS001","AZF001","New","PPO","Silver","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$40.12","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"0.979041740221648",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritusaz.com/formulary.html","92045AZ0090001-06","94% AV Level Silver Plan","94.49%","0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","Individual","No","27-3835905","92045AZ0110001","Meritus Lifestyle Choice Bronze","92045AZ011",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0110001-00","Standard Bronze Off Exchange Plan","59.21%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0240001","Meritus Bronze Lifestyle","92045AZ024",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0240001-00","Standard Bronze Off Exchange Plan","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0240001","Meritus Bronze Lifestyle","92045AZ024",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0240001-01","Standard Bronze On Exchange Plan","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","Individual","No","27-3835905","92045AZ0110001","Meritus Lifestyle Choice Bronze","92045AZ011",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0110001-01","Standard Bronze On Exchange Plan","59.21%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","Individual","No","27-3835905","92045AZ0110001","Meritus Lifestyle Choice Bronze","92045AZ011",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0110001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","6","92045","AZ","Individual","No","27-3835905","92045AZ0110001","Meritus Lifestyle Choice Bronze","92045AZ011",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0110001-03","Limited Cost Sharing Plan Variation","59.21%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0100001","Meritus Saver Choice Bronze","92045AZ010",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0100001-00","Standard Bronze Off Exchange Plan","61.10%","0.61103343963623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0230001","Meritus Bronze Saver","92045AZ023",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0230001-00","Standard Bronze Off Exchange Plan","61.10%","0.61103343963623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","SHOP (Small Group)","No","27-3835905","92045AZ0230001","Meritus Bronze Saver","92045AZ023",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastic Surgeon; Rehabilitation Services; Sleep Studies",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0230001-01","Standard Bronze On Exchange Plan","61.10%","0.61103343963623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0100001","Meritus Saver Choice Bronze","92045AZ010",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0100001-01","Standard Bronze On Exchange Plan","61.10%","0.61103343963623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0100001","Meritus Saver Choice Bronze","92045AZ010",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0100001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0100001","Meritus Saver Choice Bronze","92045AZ010",,"AZN001","AZS001","AZF002","New","PPO","Bronze","Yes","Both","No","Yes","Pain Management; Plastics; Rehabilitation Services; Sleep Studies",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Heart Disease, Depression,  Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0100001-03","Limited Cost Sharing Plan Variation","61.10%","0.61103343963623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0120001","Meritus Confident Choice","92045AZ012",,"AZN001","AZS001","AZF002","New","PPO","Catastrophic","No","Both","No","Yes","Allergist, Dermatologist, Cardiac Surgeon, Genetics, Pain Management, Orthodpedic Surgeon, Otolarynologist, Plastic Surgeon, Podiatrist, Psychiatrist, Rehabilitation Services, Radiology and Imaging",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0120001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AZ","92045","HIOS","6","2013-11-23 14:44:18","7","92045","AZ","Individual","No","27-3835905","92045AZ0120001","Meritus Confident Choice","92045AZ012",,"AZN001","AZS001","AZF002","New","PPO","Catastrophic","No","Both","No","Yes","Allergist, Dermatologist, Cardiac Surgeon, Genetics, Pain Management, Orthodpedic Surgeon, Otolarynologist, Plastic Surgeon, Podiatrist, Psychiatrist, Rehabilitation Services, Radiology and Imaging",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.meritusaz.com/ppo-summary-of-benefits.html","https://enroll.meritusaz.com/ehp/eapp/samlpaymentacs","http://www.meritusaz.com/ppo-plan-brochure.html","http://www.meritushealthpartners.org/formulary.html","92045AZ0120001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","Individual","Yes","86-0307623","99180AZ0010002","Smile for Health Family C60A70","99180AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0150001","Smile for Health Child C80A80","99180AZ015",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c80a80-ppo.pdf",,,,"99180AZ0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","Individual","Yes","86-0307623","99180AZ0010002","Smile for Health Family C60A70","99180AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0150001","Smile for Health Child C80A80","99180AZ015",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c80a80-ppo.pdf",,,,"99180AZ0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0150002","Smile for Health Family C80A80","99180AZ015",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c80a80-ppo.pdf",,,,"99180AZ0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","1","99180","AZ","Individual","Yes","86-0307623","99180AZ0010001","Smile for Health Child C60A70","99180AZ001",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","2","99180","AZ","Individual","Yes","86-0307623","99180AZ0170001","Smile for Health Child C60","99180AZ017",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/docs/plan-brochure-az-idental.pdf",,,"99180AZ0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","2","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0120001","Smile for Health Child C60A50","99180AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a50-ppo.pdf",,,,"99180AZ0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","2","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0120001","Smile for Health Child C60A50","99180AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a50-ppo.pdf",,,,"99180AZ0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","2","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0120002","Smile for Health Family C60A50","99180AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a50-ppo.pdf",,,,"99180AZ0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","2","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0120002","Smile for Health Family C60A50","99180AZ012",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a50-ppo.pdf",,,,"99180AZ0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","3","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0190001","Smile for Health Child C60","99180AZ019",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","3","99180","AZ","Individual","Yes","86-0307623","99180AZ0020001","Smile for Health Child C60A60","99180AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","3","99180","AZ","Individual","Yes","86-0307623","99180AZ0020001","Smile for Health Child C60A60","99180AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","3","99180","AZ","Individual","Yes","86-0307623","99180AZ0020002","Smile for Health Family C60A60","99180AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","3","99180","AZ","Individual","Yes","86-0307623","99180AZ0020002","Smile for Health Family C60A60","99180AZ002",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","Individual","Yes","86-0307623","99180AZ0040001","Smile for Health Child C60A50","99180AZ004",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0100002","Smile for Health Family C60A60","99180AZ010",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a60-ppo.pdf",,,,"99180AZ0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","4","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0100002","Smile for Health Family C60A60","99180AZ010",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a60-ppo.pdf",,,,"99180AZ0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","5","99180","AZ","Individual","Yes","86-0307623","99180AZ0180001","Smile for Health Child C80","99180AZ018",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$42.52",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","5","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0090001","Smile for Health Child C60A70","99180AZ009",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a70-ppo.pdf",,,,"99180AZ0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","5","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0090001","Smile for Health Child C60A70","99180AZ009",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-child-c60a70-ppo.pdf",,,,"99180AZ0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","5","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0090002","Smile for Health Family C60A70","99180AZ009",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a70-ppo.pdf",,,,"99180AZ0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","5","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0090002","Smile for Health Family C60A70","99180AZ009",,"AZN001","AZS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-grp-family-c60a70-ppo.pdf",,,,"99180AZ0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","Individual","Yes","86-0307623","99180AZ0070001","Smile for Health Child C80A80","99180AZ007",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.91",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0110001","Smile for Health Child C60A80","99180AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","Individual","Yes","86-0307623","99180AZ0070001","Smile for Health Child C80A80","99180AZ007",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.91",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0110002","Smile for Health Family C60A80","99180AZ011",,"AZN001","AZS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$27.15",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","Individual","Yes","86-0307623","99180AZ0070002","Smile for Health Family C80A80","99180AZ007",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$42.52",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","6","99180","AZ","Individual","Yes","86-0307623","99180AZ0070002","Smile for Health Family C80A80","99180AZ007",,"AZN001","AZS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$42.52",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-az-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-az-idental",,,"99180AZ0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","7","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0200001","Smile for Health Child C80","99180AZ020",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","8","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0160001","Smile for Health Child C80A50","99180AZ016",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","8","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0160002","Smile for Health Family C80A50","99180AZ016",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","9","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0140001","Smile for Health Child C80A60","99180AZ014",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","9","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0140002","Smile for Health Family C80A60","99180AZ014",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","10","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0130001","Smile for Health Child C80A70","99180AZ013",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AZ","99180","HIOS","7","2013-09-12 11:27:35","10","99180","AZ","SHOP (Small Group)","Yes","86-0307623","99180AZ0130002","Smile for Health Family C80A70","99180AZ013",,"AZN001","AZS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"99180AZ0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0010001","Guardian Pediatric Advantage","15833FL001",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0010001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0010001","Guardian Pediatric Advantage","15833FL001",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0010001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0020001","Guardian Pediatric Essentials","15833FL002",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0020001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","1","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0020001","Guardian Pediatric Essentials","15833FL002",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0020001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","2","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0030001","Guardian Family Advantage Plus","15833FL003",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0030001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120034","BlueSelect Predictable Cost Plus 1446P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1446P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120034-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-00","Standard Silver Off Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0120035","BlueSelect Predictable Cost Plus 1456P","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120035-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","4","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0040001","Guardian Family Advantage","15833FL004",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0040001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","4","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0040001","Guardian Family Advantage","15833FL004",,"FLN001","FLS002",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0040001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","15833","HIOS","7","2013-09-12 11:27:35","4","15833","FL","SHOP (Small Group)","Yes","13-5123390","15833FL0060001","Guardian Family Essentials","15833FL006",,"FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"15833FL0060001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","1","16842","FL","Individual","No","59-2015694","16842FL0120033","BlueSelect Predictable Cost 1456","16842FL012",,"FLN002","FLS002","FLF016","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1456_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120033-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070096","BlueOptions Essential (HSA) Plus 1419P","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070096-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070096","BlueOptions Essential (HSA) Plus 1419P","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070096-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070096","BlueOptions Essential (HSA) Plus 1419P","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070096-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070110-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070110-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120064","BlueSelect Everyday Health Plus 1451P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120064-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120064","BlueSelect Everyday Health Plus 1451P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120064-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1210001","SG Value Silver 50 2000","27357FL121",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985034094180597",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1210001-00","Standard Silver Off Exchange Plan","68.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$6,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","6","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1210001","SG Value Silver 50 2000","27357FL121",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985034094180597",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1210001-01","Standard Silver On Exchange Plan","68.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$6,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1220001","SG Value Gold 100 2000","27357FL122",,"FLN001","FLS001","FLF012","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.987961795474283",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1220001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","7","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1220001","SG Value Gold 100 2000","27357FL122",,"FLN001","FLS001","FLF012","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.987961795474283",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1220001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1230001","SG Value Gold 50 500","27357FL123",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988194808790724",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1230001-00","Standard Gold Off Exchange Plan","79.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","8","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1230001","SG Value Gold 50 500","27357FL123",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988194808790724",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1230001-01","Standard Gold On Exchange Plan","79.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070096","BlueOptions Essential (HSA) Plus 1419P","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070096-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070099","BlueOptions Essential (HSA) Plus 1430P","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070099-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070088","BlueOptions Essential Plus 1401P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070088-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070088","BlueOptions Essential Plus 1401P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070088-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070104","BlueOptions Everyday Health Plus 1418P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070104-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070104","BlueOptions Everyday Health Plus 1418P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070104-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070104","BlueOptions Everyday Health Plus 1418P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070104-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070104","BlueOptions Everyday Health Plus 1418P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070104-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070099","BlueOptions Essential (HSA) Plus 1430P","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070099-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070099","BlueOptions Essential (HSA) Plus 1430P","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070099-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070099","BlueOptions Essential (HSA) Plus 1430P","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070099-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120048","BlueSelect Essential Plus 1434P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120048-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120048","BlueSelect Essential Plus 1434P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120048-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070074","BlueOptions Predictable Cost Plus 1413P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070074-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070074","BlueOptions Predictable Cost Plus 1413P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070074-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070074","BlueOptions Predictable Cost Plus 1413P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070074-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070074","BlueOptions Predictable Cost Plus 1413P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1413P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070074-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-00","Standard Silver Off Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","2","16842","FL","Individual","No","59-2015694","16842FL0070075","BlueOptions Predictable Cost Plus 1423P","16842FL007",,"FLN001","FLS001","FLF005","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1423P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070075-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070076","BlueOptions Essential 1401","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070076-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070076","BlueOptions Essential 1401","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070076-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070076","BlueOptions Essential 1401","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070076-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070076","BlueOptions Essential 1401","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070076-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070081","BlueOptions Essential 1406","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070081-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential (HSA) 1419","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070084-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential (HSA) 1419","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070084-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070084","BlueOptions Essential (HSA) 1419","16842FL007",,"FLN001","FLS001","FLF029","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1419_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070084-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070087","BlueOptions Essential (HSA) 1430","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070087-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120048","BlueSelect Essential Plus 1434P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120048-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120048","BlueSelect Essential Plus 1434P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"25"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120063","BlueSelect Everyday Health 1453","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120063-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120063","BlueSelect Everyday Health 1453","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120063-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070105","BlueOptions Everyday Health Plus 1420P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070105-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070105","BlueOptions Everyday Health Plus 1420P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070105-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070105","BlueOptions Everyday Health Plus 1420P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070105-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0070105","BlueOptions Everyday Health Plus 1420P","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070105-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120063","BlueSelect Everyday Health 1453","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120063-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120063","BlueSelect Everyday Health 1453","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120063-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070087","BlueOptions Essential (HSA) 1430","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070087-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070087","BlueOptions Essential (HSA) 1430","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070087-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0070087","BlueOptions Essential (HSA) 1430","16842FL007",,"FLN001","FLS001","FLF030","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1430_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070087-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120036","BlueSelect Essential 1434","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120036-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120036","BlueSelect Essential 1434","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120036-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120036","BlueSelect Essential 1434","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"25"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120036","BlueSelect Essential 1434","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1434_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120036-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120041","BlueSelect Essential 1439","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120041-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential (HSA) 1452","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120044-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential (HSA) 1452","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120044-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential (HSA) 1452","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"36"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120044","BlueSelect Essential (HSA) 1452","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120044-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120047","BlueSelect Essential (HSA) 1463","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120047-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","3","16842","FL","Individual","No","59-2015694","16842FL0120047","BlueSelect Essential (HSA) 1463","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120047-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070088","BlueOptions Essential Plus 1401P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070088-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070088","BlueOptions Essential Plus 1401P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1401P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070088-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$5,200","$10,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0070093","BlueOptions Essential Plus 1406P","16842FL007",,"FLN001","FLS001","FLF003","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1406P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070093-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0070114","BlueOptions Everyday Health 1410","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070114-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070110-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0070110","BlueOptions All Copay 1424","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070110-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120053","BlueSelect Essential Plus 1439P","16842FL012",,"FLN002","FLS002","FLF014","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1439P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120053-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$8,400","$16,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120056","BlueSelect Essential (HSA) Plus 1452P","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120056-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120056","BlueSelect Essential (HSA) Plus 1452P","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120056-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120056","BlueSelect Essential (HSA) Plus 1452P","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"36"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120056","BlueSelect Essential (HSA) Plus 1452P","16842FL012",,"FLN002","FLS002","FLF015","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1452P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120056-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120059","BlueSelect Essential (HSA) Plus 1463P","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120059-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120059","BlueSelect Essential (HSA) Plus 1463P","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120059-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120059","BlueSelect Essential (HSA) Plus 1463P","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120059-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"40"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","4","16842","FL","Individual","No","59-2015694","16842FL0120059","BlueSelect Essential (HSA) Plus 1463P","16842FL012",,"FLN002","FLS002","FLF031","New","EPO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1463P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120059-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0070100","BlueOptions Everyday Health 1431","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070100-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0070109","BlueOptions Everyday Health Plus 1416P","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070109-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0070109","BlueOptions Everyday Health Plus 1416P","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070109-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","2","30115","FL","Individual","Yes","58-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf",,"30115FL0020001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","2","30115","FL","Individual","Yes","58-2876465","30115FL0020001","BlueDental Choice Q","30115FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_Q_Plan_Brochure.pdf",,"30115FL0020001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","4","30115","FL","Individual","Yes","58-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf",,"30115FL0050001-00","Standard High Off Exchange Plan","86.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","4","30115","FL","Individual","Yes","58-2876465","30115FL0050001","BlueDental Choice QF","30115FL005",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Choice_QF_Plan_Brochure.pdf",,"30115FL0050001-01","Standard High On Exchange Plan","86.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","5","16842","FL","Individual","No","59-2015694","16842FL0120060","BlueSelect Everyday Health 1464","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120060-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120065","BlueSelect Everyday Health Plus 1453P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120065-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120065","BlueSelect Everyday Health Plus 1453P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120065-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120065","BlueSelect Everyday Health Plus 1453P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120065-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120065","BlueSelect Everyday Health Plus 1453P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120065-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070102-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070102-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070102-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070102","BlueOptions Everyday Health 1418","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070102-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070103","BlueOptions Everyday Health 1420","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070103-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070103","BlueOptions Everyday Health 1420","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070103-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070103","BlueOptions Everyday Health 1420","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070103-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0070103","BlueOptions Everyday Health 1420","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070103-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120062-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120062-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120062-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","7","16842","FL","Individual","No","59-2015694","16842FL0120062","BlueSelect Everyday Health 1451","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120062-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,000","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0070101","BlueOptions Everyday Health Plus 1431P","16842FL007",,"FLN001","FLS001","FLF008","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1431P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070101-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,000","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","6","16842","FL","Individual","No","59-2015694","16842FL0120061","BlueSelect Everyday Health Plus 1464P","16842FL012",,"FLN002","FLS002","FLF019","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1464P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120061-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0120071","BlueSelect All Copay Plus 1457P","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120071-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0120071","BlueSelect All Copay Plus 1457P","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120071-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0120071","BlueSelect All Copay Plus 1457P","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120071-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0120071","BlueSelect All Copay Plus 1457P","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120071-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120064","BlueSelect Everyday Health Plus 1451P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120064-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","8","16842","FL","Individual","No","59-2015694","16842FL0120064","BlueSelect Everyday Health Plus 1451P","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120064-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.946489377513043",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070106-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.946489377513043",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070106-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.946489377513043",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070106-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070106","BlueOptions Everyday Health Premier 1418V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.946489377513043",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1418V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070106-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","14","16842","FL","Individual","No","59-2015694","16842FL0120072","BlueSelect Everyday Health 1443","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120072-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","8","23841","FL","Individual","No","06-6033492","23841FL0080007","Aetna Premier 2000 PD","23841FL008",,"FLN001","FLS001","FLF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","8","23841","FL","Individual","No","06-6033492","23841FL0080007","Aetna Premier 2000 PD","23841FL008",,"FLN001","FLS001","FLF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1160001","SG Value Bronze 100 5500","27357FL116",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.981344031894805",,,"0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Urgent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1160001-00","Standard Bronze Off Exchange Plan","61.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","1","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1160001","SG Value Bronze 100 5500","27357FL116",,"FLN001","FLS001","FLF012","New","HMO","Bronze","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.981344031894805",,,"0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Urgent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1160001-01","Standard Bronze On Exchange Plan","61.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1170001","SG Value Silver 90 2500","27357FL117",,"FLN001","FLS001","FLF013","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985447114670223",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1170001-00","Standard Silver Off Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","1","23841","FL","Individual","No","06-6033492","23841FL0080001","Aetna Advantage 5750 PD","23841FL008",,"FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","2","23841","FL","Individual","No","06-6033492","23841FL0080002","Aetna Advantage 6350","23841FL008",,"FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","4","23841","FL","Individual","No","06-6033492","23841FL0080004","Aetna AdvantagePlus 5500 PD","23841FL008",,"FLN001","FLS001","FLF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","4","23841","FL","Individual","No","06-6033492","23841FL0080004","Aetna AdvantagePlus 5500 PD","23841FL008",,"FLN001","FLS001","FLF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","4","23841","FL","Individual","No","06-6033492","23841FL0080004","Aetna AdvantagePlus 5500 PD","23841FL008",,"FLN001","FLS001","FLF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0070115","BlueOptions Everyday Health Plus 1410P","16842FL007",,"FLN001","FLS001","FLF009","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1410P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070115-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$23,000","$25,000","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$23,000","$25,000","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070107","BlueOptions Everyday Health Premier 1420V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.952134236516911",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070107-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070107","BlueOptions Everyday Health Premier 1420V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.952134236516911",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070107-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070107","BlueOptions Everyday Health Premier 1420V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.952134236516911",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070107-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0070107","BlueOptions Everyday Health Premier 1420V","16842FL007",,"FLN001","FLS001","FLF002","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.952134236516911",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1420V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070107-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.937040000349633",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120066-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.937040000349633",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120066-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.937040000349633",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120066-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120066","BlueSelect Everyday Health Premier 1451V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.937040000349633",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1451V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120066-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,400","$10,800","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"$2,550","$5,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120067","BlueSelect Everyday Health Premier 1453V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.943620235316184",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120067-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120067","BlueSelect Everyday Health Premier 1453V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.943620235316184",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120067-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0120069","BlueSelect Everyday Health Plus 1449P","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120069-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0120069","BlueSelect Everyday Health Plus 1449P","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120069-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0120069","BlueSelect Everyday Health Plus 1449P","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120069-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0120069","BlueSelect Everyday Health Plus 1449P","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120069-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120070-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120070-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120070-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","12","16842","FL","Individual","No","59-2015694","16842FL0120070","BlueSelect All Copay 1457","16842FL012",,"FLN002","FLS002","FLF018","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1457_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120070-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0070111","BlueOptions All Copay Plus 1424P","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070111-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0070111","BlueOptions All Copay Plus 1424P","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070111-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0070111","BlueOptions All Copay Plus 1424P","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070111-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","13","16842","FL","Individual","No","59-2015694","16842FL0070111","BlueOptions All Copay Plus 1424P","16842FL007",,"FLN001","FLS001","FLF007","New","EPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1424P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070111-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$500","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120067","BlueSelect Everyday Health Premier 1453V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.943620235316184",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120067-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","9","16842","FL","Individual","No","59-2015694","16842FL0120067","BlueSelect Everyday Health Premier 1453V","16842FL012",,"FLN002","FLS002","FLF013","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.943620235316184",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1453V_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120067-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$16,000","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070108-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070108-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070108-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0070108","BlueOptions Everyday Health 1416","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070108-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120068-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120068-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120068-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","10","16842","FL","Individual","No","59-2015694","16842FL0120068","BlueSelect Everyday Health 1449","16842FL012",,"FLN002","FLS002","FLF017","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1449_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120068-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0070109","BlueOptions Everyday Health Plus 1416P","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070109-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","11","16842","FL","Individual","No","59-2015694","16842FL0070109","BlueOptions Everyday Health Plus 1416P","16842FL007",,"FLN001","FLS001","FLF006","New","EPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1416P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070109-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","8","23841","FL","Individual","No","06-6033492","23841FL0080007","Aetna Premier 2000 PD","23841FL008",,"FLN001","FLS001","FLF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","9","23841","FL","Individual","No","06-6033492","23841FL0080005","Aetna Basic","23841FL008",,"FLN001","FLS001","FLF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","1","23841","FL","Individual","No","06-6033492","23841FL0080001","Aetna Advantage 5750 PD","23841FL008",,"FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","1","23841","FL","Individual","No","06-6033492","23841FL0080001","Aetna Advantage 5750 PD","23841FL008",,"FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","2","23841","FL","Individual","No","06-6033492","23841FL0080002","Aetna Advantage 6350","23841FL008",,"FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","2","23841","FL","Individual","No","06-6033492","23841FL0080002","Aetna Advantage 6350","23841FL008",,"FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","15","16842","FL","Individual","No","59-2015694","16842FL0120073","BlueSelect Everyday Health Plus 1443P","16842FL012",,"FLN002","FLS002","FLF025","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1443P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0120073-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$23,000","$25,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$11,500","$23,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","16842","HIOS","6","2014-01-17 09:36:20","16","16842","FL","Individual","No","59-2015694","16842FL0070112","BlueOptions Catastrophic 1433","16842FL007",,"FLN001","FLS001","FLF027","New","EPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Covered services as outlined in the member contract","Yes","Covered services as outlined in the member contract","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1433_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1433_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","16842FL0070112-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","5","23841","FL","Individual","No","06-6033492","23841FL0080008","Aetna Classic 3500 PD","23841FL008",,"FLN001","FLS001","FLF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","23841","HIOS","6","2013-11-26 13:14:08","6","23841","FL","Individual","No","06-6033492","23841FL0080009","Aetna Classic 5000","23841FL008",,"FLN001","FLS001","FLF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997396950065546",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/fl.html","23841FL0080009-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","2","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1170001","SG Value Silver 90 2500","27357FL117",,"FLN001","FLS001","FLF013","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985447114670223",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1170001-01","Standard Silver On Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1180001","SG Value Silver 80 5000","27357FL118",,"FLN001","FLS001","FLF006","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985606019084209",,,"0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Urgent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1180001-00","Standard Silver Off Exchange Plan","70.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","3","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1180001","SG Value Silver 80 5000","27357FL118",,"FLN001","FLS001","FLF006","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985606019084209",,,"0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Urgent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1180001-01","Standard Silver On Exchange Plan","70.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1190001","SG Value Silver 80 2000","27357FL119",,"FLN001","FLS001","FLF014","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985757618876482",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1190001-00","Standard Silver Off Exchange Plan","71.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","4","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1190001","SG Value Silver 80 2000","27357FL119",,"FLN001","FLS001","FLF014","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985757618876482",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1190001-01","Standard Silver On Exchange Plan","71.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1200001","SG Value Silver 100 3000","27357FL120",,"FLN001","FLS001","FLF012","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985734713400648",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1200001-00","Standard Silver Off Exchange Plan","71.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","5","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1200001","SG Value Silver 100 3000","27357FL120",,"FLN001","FLS001","FLF012","New","HMO","Silver","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985734713400648",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1200001-01","Standard Silver On Exchange Plan","71.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","9","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1240001","SG Value Gold 50 1000","27357FL124",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98811113144339",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1240001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","9","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1240001","SG Value Gold 50 1000","27357FL124",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98811113144339",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1240001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","10","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1250001","SG Value Gold 80 1000","27357FL125",,"FLN001","FLS001","FLF014","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988110059342875",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1250001-00","Standard Gold Off Exchange Plan","79.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","10","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1250001","SG Value Gold 80 1000","27357FL125",,"FLN001","FLS001","FLF014","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988110059342875",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1250001-01","Standard Gold On Exchange Plan","79.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1260001","SG Value Platinum 80 0 3000","27357FL126",,"FLN001","FLS001","FLF006","New","HMO","Platinum","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.990331397198778",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1260001-00","Standard Platinum Off Exchange Plan","89.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","11","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1260001","SG Value Platinum 80 0 3000","27357FL126",,"FLN001","FLS001","FLF006","New","HMO","Platinum","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.990331397198778",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1260001-01","Standard Platinum On Exchange Plan","89.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1270001","SG Value Gold 80 500 6000 25","27357FL127",,"FLN001","FLS001","FLF010","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988261464399229",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1270001-00","Standard Gold Off Exchange Plan","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","12","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1270001","SG Value Gold 80 500 6000 25","27357FL127",,"FLN001","FLS001","FLF010","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988261464399229",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1270001-01","Standard Gold On Exchange Plan","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1280001","SG Value Gold 80 500 6000 40","27357FL128",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988719756335562",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1280001-00","Standard Gold Off Exchange Plan","81.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","13","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1280001","SG Value Gold 80 500 6000 40","27357FL128",,"FLN001","FLS001","FLF006","New","HMO","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988719756335562",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1280001-01","Standard Gold On Exchange Plan","81.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1290001","SG ValuePOS Gold 80 1000","27357FL129",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988813950287077",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1290001-00","Standard Gold Off Exchange Plan","78.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","14","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1290001","SG ValuePOS Gold 80 1000","27357FL129",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988813950287077",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1290001-01","Standard Gold On Exchange Plan","78.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1300001","SG ValuePOS Gold 80 1500","27357FL130",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988891561068681",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1300001-00","Standard Gold Off Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","15","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1300001","SG ValuePOS Gold 80 1500","27357FL130",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988891561068681",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1300001-01","Standard Gold On Exchange Plan","78.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1310001","SG ValuePOS Gold 80 2500","27357FL131",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989130681946821",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1310001-00","Standard Gold Off Exchange Plan","80.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","27357","HIOS","8","2014-03-19 07:06:49","16","27357","FL","SHOP (Small Group)","No","59-3315064","27357FL1310001","SG ValuePOS Gold 80 2500","27357FL131",,"FLN001","FLS001","FLF006","New","POS","Gold","Yes","Both","No","No",,"No coverage for non-emergent, non-urgent, out out-of-network services unless plan authorization is obtained unless utilizing POS benefit.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989130681946821",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Ugent and Emergent Services","No","www.HealthFirstHealthPlans.org/MHS",,"www.HealthFirstHealthPlans.org/MHS","www.healthfirsthealthplans.org","27357FL1310001-01","Standard Gold On Exchange Plan","80.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","1","30115","FL","Individual","Yes","58-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf",,"30115FL0010001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","1","30115","FL","Individual","Yes","58-2876465","30115FL0010001","BlueDental Copayment Q","30115FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_Q_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_Q_Plan_Brochure.pdf",,"30115FL0010001-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential (HSA) 1486","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020044-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential (HSA) 1486","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020044-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential (HSA) 1486","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020044-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020044","BlueCare Essential (HSA) 1486","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020044-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020047","BlueCare Essential (HSA) 1497","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020047-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020047","BlueCare Essential (HSA) 1497","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020047-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020047","BlueCare Essential (HSA) 1497","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020047-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","5","30115","FL","Individual","Yes","58-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf",,"30115FL0040001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30115","HIOS","7","2013-09-19 06:29:55","5","30115","FL","Individual","Yes","58-2876465","30115FL0040001","BlueDental Copayment QF","30115FL004",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of service area benefits are available as defined in the policy but may have a higher cost share","Yes","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/ BlueDental_Copayment_QF_Plan_Benefit_Summary.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.floridabluedental.com/~/media/FloridaBlueDental/Files/BlueDental_Copayment_QF_Plan_Brochure.pdf",,"30115FL0040001-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30219","HIOS","6","2013-10-15 07:27:56","1","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN003","FLS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032",,"30219FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30219","HIOS","6","2013-10-15 07:27:56","1","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0030001","Family Basic Dental Plan (Low)","30219FL003",,"FLN003","FLS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48033",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48032",,"30219FL0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020036","BlueCare Essential 1468","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020036","BlueCare Essential 1468","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020036-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020041","BlueCare Essential 1473","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020041-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020034","BlueCare Predictable Cost Plus 1480P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020034-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020059","BlueCare Essential (HSA) Plus 1497P","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020059-00","Standard Bronze Off Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020059","BlueCare Essential (HSA) Plus 1497P","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020059-01","Standard Bronze On Exchange Plan","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","6","30252","FL","Individual","No","59-2403696","30252FL0020061","BlueCare Everyday Health Plus 1498P","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020061-06","94% AV Level Silver Plan","93.57%","0.939414799213409","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020059","BlueCare Essential (HSA) Plus 1497P","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020059-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020059","BlueCare Essential (HSA) Plus 1497P","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020059-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-00","Standard Silver Off Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-01","Standard Silver On Exchange Plan","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-03","Limited Cost Sharing Plan Variation","68.27%","0.683605074882507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-04","73% AV Level Silver Plan","73.54%","0.735352694988251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","5","30252","FL","Individual","No","59-2403696","30252FL0020060","BlueCare Everyday Health 1498","30252FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1498_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020060-05","87% AV Level Silver Plan","86.31%","0.894366383552551","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020048","BlueCare Essential Plus 1468P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020048-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020048","BlueCare Essential Plus 1468P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020048-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020048","BlueCare Essential Plus 1468P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020048-03","Limited Cost Sharing Plan Variation","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-00","Standard Silver Off Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-01","Standard Silver On Exchange Plan","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-03","Limited Cost Sharing Plan Variation","70.84%","0.705318629741669","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-04","73% AV Level Silver Plan","73.86%","0.735324621200562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-05","87% AV Level Silver Plan","86.18%","0.860330820083618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020053","BlueCare Essential Plus 1473P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1473P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020053-06","94% AV Level Silver Plan","93.18%","0.930642306804657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020056","BlueCare Essential (HSA) Plus 1486P","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020056-00","Standard Bronze Off Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020056","BlueCare Essential (HSA) Plus 1486P","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020056-01","Standard Bronze On Exchange Plan","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020056","BlueCare Essential (HSA) Plus 1486P","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020056-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020056","BlueCare Essential (HSA) Plus 1486P","30252FL002",,"FLN001","FLS001","FLF004","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1486P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020056-03","Limited Cost Sharing Plan Variation","58.34%","0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020047","BlueCare Essential (HSA) 1497","30252FL002",,"FLN001","FLS001","FLF015","New","HMO","Bronze","Yes","Both","No","No",,"Standard plan is HSA Compatible","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1497_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020047-03","Limited Cost Sharing Plan Variation","61.27%","0.6119464635849","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","4","30252","FL","Individual","No","59-2403696","30252FL0020048","BlueCare Essential Plus 1468P","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020048-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","30219","HIOS","6","2013-10-15 07:27:56","2","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN004","FLS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$13.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073",,"30219FL0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30219","HIOS","6","2013-10-15 07:27:56","2","30219","FL","SHOP (Small Group)","Yes","65-0073323","30219FL0040001","Family Enhanced Dental Plan (High)","30219FL004",,"FLN004","FLS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$13.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49074",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49073",,"30219FL0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010001","BlueCare Essential Health S1450","30252FL001",,"FLN001","FLS001","FLF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","www.bcbsfl.com/DocumentLibrary/SBC/2014/S1450.pdf","www.floridablue.com/shopmarketplacethankyou","www.bcbsfl.com/DocumentLibrary/MiniSummary/2014/S1450.pdf","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0010001-01","Standard Silver On Exchange Plan","69.70%","0.696754574775696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020032","BlueCare Predictable Cost 1480","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020032-00","Standard Gold Off Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020032","BlueCare Predictable Cost 1480","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020032-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","SHOP (Small Group)","No","59-2403696","30252FL0010002","BlueCare Essential Health S1451","30252FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","www.bcbsfl.com/DocumentLibrary/SBC/2014/S1451.pdf","www.floridablue.com/shopmarketplacethankyou","www.bcbsfl.com/DocumentLibrary/MiniSummary/2014/S1451.pdf","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0010002-01","Standard Gold On Exchange Plan","78.20%","0.782234013080597","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020032","BlueCare Predictable Cost 1480","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020032-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020032","BlueCare Predictable Cost 1480","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020032-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-00","Standard Silver Off Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","1","30252","FL","Individual","No","59-2403696","30252FL0020033","BlueCare Predictable Cost 1490","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020033-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020034","BlueCare Predictable Cost Plus 1480P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020034-01","Standard Gold On Exchange Plan","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020034","BlueCare Predictable Cost Plus 1480P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020034","BlueCare Predictable Cost Plus 1480P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1480P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020034-03","Limited Cost Sharing Plan Variation","78.52%","0.854674756526947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-00","Standard Silver Off Exchange Plan","68.55%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-01","Standard Silver On Exchange Plan","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-03","Limited Cost Sharing Plan Variation","68.65%","0.779281556606293","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-04","73% AV Level Silver Plan","73.15%","0.793824434280396","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-05","87% AV Level Silver Plan","86.46%","0.864597499370575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","2","30252","FL","Individual","No","59-2403696","30252FL0020035","BlueCare Predictable Cost Plus 1490P","30252FL002",,"FLN001","FLS001","FLF005","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1490P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020035-06","94% AV Level Silver Plan","93.23%","0.932262361049652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020036","BlueCare Essential 1468","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020036-00","Standard Gold Off Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","3","30252","FL","Individual","No","59-2403696","30252FL0020036","BlueCare Essential 1468","30252FL002",,"FLN001","FLS001","FLF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1468_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020036-01","Standard Gold On Exchange Plan","78.33%","0.780430674552917","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020062-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020062-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020062-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020062","BlueCare Everyday Health 1485","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020062-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020063","BlueCare Everyday Health 1487","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020063-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020063","BlueCare Everyday Health 1487","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020063-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020063","BlueCare Everyday Health 1487","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020063-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","7","30252","FL","Individual","No","59-2403696","30252FL0020063","BlueCare Everyday Health 1487","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020063-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020064","BlueCare Everyday Health Plus 1485P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020064-00","Standard Platinum Off Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020064","BlueCare Everyday Health Plus 1485P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020064-01","Standard Platinum On Exchange Plan","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020064","BlueCare Everyday Health Plus 1485P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020064-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020064","BlueCare Everyday Health Plus 1485P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1485P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020064-03","Limited Cost Sharing Plan Variation","88.14%","0.881380200386047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$850","$1,700","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020065","BlueCare Everyday Health Plus 1487P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020065-00","Standard Gold Off Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020065","BlueCare Everyday Health Plus 1487P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020065-01","Standard Gold On Exchange Plan","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020065","BlueCare Everyday Health Plus 1487P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020065-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","8","30252","FL","Individual","No","59-2403696","30252FL0020065","BlueCare Everyday Health Plus 1487P","30252FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1487P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020065-03","Limited Cost Sharing Plan Variation","78.15%","0.781451940536499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","9","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020066-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","9","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020066-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","9","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020066-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","9","30252","FL","Individual","No","59-2403696","30252FL0020066","BlueCare Everyday Health 1483","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020066-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","10","30252","FL","Individual","No","59-2403696","30252FL0020067","BlueCare Everyday Health Plus 1483P","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020067-00","Standard Bronze Off Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","10","30252","FL","Individual","No","59-2403696","30252FL0020067","BlueCare Everyday Health Plus 1483P","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020067-01","Standard Bronze On Exchange Plan","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","10","30252","FL","Individual","No","59-2403696","30252FL0020067","BlueCare Everyday Health Plus 1483P","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020067-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","10","30252","FL","Individual","No","59-2403696","30252FL0020067","BlueCare Everyday Health Plus 1483P","30252FL002",,"FLN001","FLS001","FLF006","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1483P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020067-03","Limited Cost Sharing Plan Variation","60.18%","0.656490862369537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","11","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020068-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","11","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020068-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","11","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020068-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","11","30252","FL","Individual","No","59-2403696","30252FL0020068","BlueCare All Copay 1491","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020068-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","12","30252","FL","Individual","No","59-2403696","30252FL0020069","BlueCare All Copay Plus 1491P","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020069-00","Standard Platinum Off Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","12","30252","FL","Individual","No","59-2403696","30252FL0020069","BlueCare All Copay Plus 1491P","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020069-01","Standard Platinum On Exchange Plan","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","12","30252","FL","Individual","No","59-2403696","30252FL0020069","BlueCare All Copay Plus 1491P","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020069-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","12","30252","FL","Individual","No","59-2403696","30252FL0020069","BlueCare All Copay Plus 1491P","30252FL002",,"FLN001","FLS001","FLF007","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1491P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020069-03","Limited Cost Sharing Plan Variation","88.75%","0.887860834598541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","13","30252","FL","Individual","No","59-2403696","30252FL0020070","BlueCare Everyday Health 1477","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020070-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-00","Standard Silver Off Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-01","Standard Silver On Exchange Plan","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-03","Limited Cost Sharing Plan Variation","68.15%","0.681538283824921","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-04","73% AV Level Silver Plan","72.78%","0.727813541889191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$9,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-05","87% AV Level Silver Plan","86.02%","0.860183298587799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","30252","HIOS","8","2014-01-17 09:36:20","14","30252","FL","Individual","No","59-2403696","30252FL0020071","BlueCare Everyday Health Plus 1477P","30252FL002",,"FLN001","FLS001","FLF011","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Accident and emergency services","Yes","Accident and emergency services","Yes","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.bcbsfl.com/wps/portal/bcbsfl/w/planpdfs/SBC/2014/1477P_menu","http://www.bcbsfl.com/DocumentLibrary/Providers/Content/MedGuide.pdf","30252FL0020071-06","94% AV Level Silver Plan","93.07%","0.914065897464752","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-05","87% AV Level Silver Plan","86.00%","0.865245342254639","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-06","94% AV Level Silver Plan","93.10%","0.933359861373901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$800","$1,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-00","Standard Silver Off Exchange Plan","69.40%","0.694043278694153","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-01","Standard Silver On Exchange Plan","69.40%","0.694043278694153","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-03","Limited Cost Sharing Plan Variation","69.40%","0.694043278694153","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-04","73% AV Level Silver Plan","72.00%","0.717439651489258","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-05","87% AV Level Silver Plan","86.20%","0.866659820079803","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","0%",,,,"$5,800","$11,600","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020007","myCigna Health Flex 5000","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020007-06","94% AV Level Silver Plan","93.40%","0.93491131067276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020010","myCigna Health Flex 1250","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020010-00","Standard Gold Off Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020010","myCigna Health Flex 1250","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020010-01","Standard Gold On Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020010","myCigna Health Flex 1250","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160017-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Direct Platinum 1000/1500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103777","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057861","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150006-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1070001","IND Essential Catastrophic HMO Partners 34","56503FL107","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1070001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610004","Gym Access SMAG Essential Plus Gold HMO with Pediatric Dental 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610004-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610004","Gym Access SMAG Essential Plus Gold HMO with Pediatric Dental 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610004-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600004","Gym Access SMAG Essential Plus Bronze HMO with Pediatric Dental 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600004-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160014-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160014-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-03","Limited Cost Sharing Plan Variation","72.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","65"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","Individual","Yes","86-0307623","49193FL0070002","Smile for Health Family C80A80","49193FL007",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","7","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0110001","Smile for Health Child C60A80","49193FL011",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","7","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0110002","Smile for Health Family C60A80","49193FL011",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1310001","IND Essential Plus Catastrophic HMO Partners 36","56503FL131","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1310001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730002","SMAG Essential Plus Gold Value POS 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730002-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","7"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160017-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020001","myCigna Health Savings 6100","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020001","myCigna Health Savings 6100","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020001-03","Limited Cost Sharing Plan Variation","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-00","Standard Silver Off Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-01","Standard Silver On Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketig/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160006-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketig/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160006-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-01","Standard Silver On Exchange Plan","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-03","Limited Cost Sharing Plan Variation","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-04","73% AV Level Silver Plan","73.80%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-06","94% AV Level Silver Plan","93.80%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020011","myCigna Copay Assure Gold","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020011-00","Standard Gold Off Exchange Plan","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020011","myCigna Copay Assure Gold","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020011-01","Standard Gold On Exchange Plan","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020011","myCigna Copay Assure Gold","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020011","myCigna Copay Assure Gold","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020011-03","Limited Cost Sharing Plan Variation","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0100001","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.70",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0070001","Delta Dental Individual PPO, EHB Certified","48129FL007",,"FLN002","FLS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0070001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0100002","Renaissance Group Dental PPO, EHB Certified","48129FL010",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0100002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150004","Humana Direct Silver 4600/6300 Plan","35783FL115",,"FLN001","FLS001","FLF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103738","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057887","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Direct Gold 2500/3500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103751","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057822","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Direct Gold 2500/3500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103751","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057822","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Direct Gold 2500/3500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103751","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057822","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150005","Humana Direct Gold 2500/3500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103751","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057822","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Direct Platinum 1000/1500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103777","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057861","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150006-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Direct Platinum 1000/1500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103777","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057861","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150006-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1150006","Humana Direct Platinum 1000/1500 Plan","35783FL115",,"FLN001","FLS001","FLF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103777","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057861","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160004","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN002","FLS002","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020010","myCigna Health Flex 1250","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020010-03","Limited Cost Sharing Plan Variation","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","6","48121","FL","Individual","No","59-1031071","48121FL0020008","myCigna Copay Assure Silver","48121FL002","7730182962","FLN001","FLS001","FLF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020008-00","Standard Silver Off Exchange Plan","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0070002","Delta Dental Individual PPO, EHB Certified","48129FL007",,"FLN002","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0160001","Renaissance Group Dental PPO, EHB Certified (Exchange)","48129FL016",,"FLN001","FLS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_EHB_Group_High",,"www.renaissancedental.com/FL_EHB_GROUP_High",,"48129FL0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0080001","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0080001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0160002","Renaissance Group Dental PPO, EHB Certified (Exchange)","48129FL016",,"FLN001","FLS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_EHB_Group_Low",,"www.renaissancedental.com/FL_EHB_GROUP_Low",,"48129FL0160002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0080002","Renaissance Individual Dental PPO, EHB Certified","48129FL008",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0080002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0130001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_EHB_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","www.renaissancedental.com/FL_EHB_Plan_Brochure",,"48129FL0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0160003","Renaissance Group Dental PPO, EHB Certified (Exchange)","48129FL016",,"FLN001","FLS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_50_50_High",,"www.renaissancedental.com/FL_50_50_High",,"48129FL0160003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","Individual","Yes","47-0397286","48129FL0130002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","48129FL013",,"FLN001","FLS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_EHB_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","www.renaissancedental.com/FL_EHB_Plan_Brochure",,"48129FL0130002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","1","48129","FL","SHOP (Small Group)","Yes","47-0397286","48129FL0160004","Renaissance Group Dental PPO, EHB Certified (Exchange)","48129FL016",,"FLN001","FLS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_50_50_Low",,"www.renaissancedental.com/FL_50_50_Low",,"48129FL0160004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0110001","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$29.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0110002","Renaissance Individual Dental Pediatric-Only, EHB Certified","48129FL011",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"48129FL0110002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0150001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$32.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_Ped_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","www.renaissancedental.com/FL_EHB_Plan_Brochure",,"48129FL0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","48129","HIOS","8","2013-11-26 13:14:08","2","48129","FL","Individual","Yes","47-0397286","48129FL0150002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","48129FL015",,"FLN001","FLS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/FL_Ped_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/48129","www.renaissancedental.com/FL_EHB_Plan_Brochure",,"48129FL0150002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0150001","Smile for Health Child C80A80","49193FL015",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c80a80-ppo.pdf",,,,"49193FL0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","8","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0130002","Smile for Health Family C80A70","49193FL013",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650020","Bronze Select BX Dade","51398FL065",,"FLN002","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650020/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650020","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650020-03","Limited Cost Sharing Plan Variation","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","90"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","54172FL0010001-01","Standard Gold On Exchange Plan","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160005","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Direct Bronze 4850/6350 Plan","35783FL115",,"FLN001","FLS001","FLF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103725","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057731","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","Individual","Yes","86-0307623","49193FL0070002","Smile for Health Family C80A80","49193FL007",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0090002","Smile for Health Family C60A70","49193FL009",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a70-ppo.pdf",,,,"49193FL0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0090002","Smile for Health Family C60A70","49193FL009",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a70-ppo.pdf",,,,"49193FL0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-05","87% AV Level Silver Plan","88.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,100","$4,200","$2,100","$4,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$400","$0","$500","$0","$1,200","$0","$80","81"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-06","94% AV Level Silver Plan","94.40%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$500","$0","$700","$0","$80","82"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650019","Bronze Select AX Dade","51398FL065",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650019/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650019","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650019-00","Standard Bronze Off Exchange Plan","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","83"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650019","Bronze Select AX Dade","51398FL065",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650019/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650019","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650019-01","Standard Bronze On Exchange Plan","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","84"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650019","Bronze Select AX Dade","51398FL065",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650019/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650019","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"85"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650019","Bronze Select AX Dade","51398FL065",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650019/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650019","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650019-03","Limited Cost Sharing Plan Variation","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","86"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1220001","Gym Access IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1220001","Gym Access IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220001-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1150001","Gym Access IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150001-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700003","SMAG Essential Plus Platinum POS with Pediatric Dental 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700003-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","7"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketig/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160006","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN002","FLS002","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketig/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160006-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-04","73% AV Level Silver Plan","73.90%","0.739199995994568","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$720","$180","$80","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680002","SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680002-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690003","SMAG Essential Plus Gold POS with Pediatric Dental 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690003-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1150004","Gym Access IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150004-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690003","SMAG Essential Plus Gold POS with Pediatric Dental 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690003-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1150004","Gym Access IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150004-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"36"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160016","Humana Connect Silver 4600/6300 Plan","35783FL116",,"FLN003","FLS003","FLF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103829","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069613","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160016-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN003","FLS003","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160015-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN003","FLS003","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160015-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN003","FLS003","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160015","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN003","FLS003","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160015-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","1","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0020001","EssentialSmile Ped 222","43274FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","1","43274","FL","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0010001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","1","43274","FL","Individual","Yes","14-1917982","43274FL0010001","EssentialSmile Ped 221","43274FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0010001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","1","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0020001","EssentialSmile Ped 222","43274FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0020001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","2","43274","FL","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0010002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","2","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0020002","EssentialSmile 222","43274FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0020002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","2","43274","FL","Individual","Yes","14-1917982","43274FL0010002","EssentialSmile 221","43274FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0010002-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160017","Humana Connect Gold 2500/3500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103842","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069626","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160017-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160018-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160018-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","1","35783","FL","Individual","No","61-1103898","35783FL1160018","Humana Connect Platinum 1000/1500 Plan","35783FL116",,"FLN003","FLS003","FLF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103855","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069639","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160018-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150001","Humana Direct Basic 6350/6350 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103699","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057796","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150001","Humana Direct Basic 6350/6350 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103699","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057796","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Direct Bronze 6300/6300 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103712","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057705","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Direct Bronze 6300/6300 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103712","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057705","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Direct Bronze 6300/6300 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103712","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057705","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1150002","Humana Direct Bronze 6300/6300 Plan","35783FL115",,"FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103712","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057705","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1150002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160001","Humana Connect Basic 6350/6350 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103790","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069574","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160001","Humana Connect Basic 6350/6350 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103790","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069574","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160002","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160013","Humana Connect Basic 6350/6350 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103790","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069574","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160013","Humana Connect Basic 6350/6350 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103790","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069574","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","2","35783","FL","Individual","No","61-1103898","35783FL1160014","Humana Connect Bronze 6300/6300 Plan","35783FL116",,"FLN003","FLS003","FLF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103803","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069587","http://apps.humana.com/marketing/documents.asp?file=2067364","35783FL1160014-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Direct Bronze 4850/6350 Plan","35783FL115",,"FLN001","FLS001","FLF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103725","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057731","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Direct Bronze 4850/6350 Plan","35783FL115",,"FLN001","FLS001","FLF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103725","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057731","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1150003","Humana Direct Bronze 4850/6350 Plan","35783FL115",,"FLN001","FLS001","FLF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103725","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057731","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1150003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","35783","HIOS","5","2014-03-19 07:06:49","3","35783","FL","Individual","No","61-1103898","35783FL1160003","Humana Connect Bronze 4850/6350 Plan","35783FL116",,"FLN002","FLS002","FLF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner Chiropractor, Podiatrist, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9965",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103816","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069600","http://apps.humana.com/marketing/documents.asp?file=2067429","35783FL1160003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","43274","HIOS","3","2013-09-17 16:07:07","2","43274","FL","SHOP (Small Group)","Yes","14-1917982","43274FL0020002","EssentialSmile 222","43274FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.70",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Available only for emergency services to treat an Emergency Condition.","Yes","Out of network coverage is available to members at the out of network cost share levels.","Yes","www.Solsticecare.com/summary-of-benefits.aspx","www.Solsticecare.com","www.solsticecare.com/plan-brochure.aspx",,"43274FL0020002-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020001","myCigna Health Savings 6100","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020001-00","Standard Bronze Off Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","Yes","59-1031071","48121FL0030001","myCigna Dental Pediatric","48121FL003","7730182962","FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"48121FL0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020001","myCigna Health Savings 6100","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020001-01","Standard Bronze On Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","Yes","59-1031071","48121FL0030001","myCigna Dental Pediatric","48121FL003","7730182962","FLN001","FLS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"48121FL0030001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-03","Limited Cost Sharing Plan Variation","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-04","73% AV Level Silver Plan","73.20%","0.684354066848755","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"$10,400","$20,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-05","87% AV Level Silver Plan","86.60%","0.812985122203827","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020004","myCigna Health Savings 3400","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020004-06","94% AV Level Silver Plan","94.30%","0.861155152320862","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","0%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020009","myCigna Health Flex 1900","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020009-00","Standard Gold Off Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020009","myCigna Health Flex 1900","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020009-01","Standard Gold On Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020009","myCigna Health Flex 1900","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","1","48121","FL","Individual","No","59-1031071","48121FL0020009","myCigna Health Flex 1900","48121FL002","7730182962","FLN001","FLS001","FLF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020009-03","Limited Cost Sharing Plan Variation","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","2","48121","FL","Individual","No","59-1031071","48121FL0020002","myCigna Health Flex 5500","48121FL002","7730182962","FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020002-00","Standard Bronze Off Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","2","48121","FL","Individual","Yes","59-1031071","48121FL0030002","myCigna Dental Family + Pediatric","48121FL003","7730182962","FLN001","FLS002",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"48121FL0030002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","2","48121","FL","Individual","No","59-1031071","48121FL0020002","myCigna Health Flex 5500","48121FL002","7730182962","FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020002-01","Standard Bronze On Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","2","48121","FL","Individual","No","59-1031071","48121FL0020002","myCigna Health Flex 5500","48121FL002","7730182962","FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","2","48121","FL","Individual","No","59-1031071","48121FL0020002","myCigna Health Flex 5500","48121FL002","7730182962","FLN001","FLS001","FLF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020002-03","Limited Cost Sharing Plan Variation","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-00","Standard Silver Off Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-01","Standard Silver On Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-03","Limited Cost Sharing Plan Variation","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-04","73% AV Level Silver Plan","72.50%","0.742465913295746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-05","87% AV Level Silver Plan","86.30%","0.867775917053223","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,500","30%",,,,"$2,900","$5,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","3","48121","FL","Individual","No","59-1031071","48121FL0020005","myCigna Health Flex 1500","48121FL002","7730182962","FLN001","FLS001","FLF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020005-06","94% AV Level Silver Plan","93.40%","0.93521922826767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"$800","$1,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","4","48121","FL","Individual","No","59-1031071","48121FL0020003","myCigna Health Flex 5100","48121FL002","7730182962","FLN001","FLS001","FLF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020003-00","Standard Bronze Off Exchange Plan","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","4","48121","FL","Individual","No","59-1031071","48121FL0020003","myCigna Health Flex 5100","48121FL002","7730182962","FLN001","FLS001","FLF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020003-01","Standard Bronze On Exchange Plan","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","4","48121","FL","Individual","No","59-1031071","48121FL0020003","myCigna Health Flex 5100","48121FL002","7730182962","FLN001","FLS001","FLF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","4","48121","FL","Individual","No","59-1031071","48121FL0020003","myCigna Health Flex 5100","48121FL002","7730182962","FLN001","FLS001","FLF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020003-03","Limited Cost Sharing Plan Variation","62.00%","0.635949313640594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-00","Standard Silver Off Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-01","Standard Silver On Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-03","Limited Cost Sharing Plan Variation","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","FL","48121","HIOS","12","2013-10-15 07:27:56","5","48121","FL","Individual","No","59-1031071","48121FL0020006","myCigna Health Flex 2750","48121FL002","7730182962","FLN001","FLS001","FLF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/florida-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/florida-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","48121FL0020006-04","73% AV Level Silver Plan","72.50%","0.73218709230423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","9","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0140001","Smile for Health Child C80A60","49193FL014",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","9","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0140002","Smile for Health Family C80A60","49193FL014",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-03","Limited Cost Sharing Plan Variation","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1150002","IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150002-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610002","SMAG Essential Plus Gold HMO 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610002-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","54172FL0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","1","54172","FL","Individual","No","26-0155137","54172FL0010001","Molina Marketplace Gold Plan","54172FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/gold","54172FL0010001-03","Limited Cost Sharing Plan Variation","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0100002","Smile for Health Family C60A60","49193FL010",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a60-ppo.pdf",,,,"49193FL0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","Individual","Yes","86-0307623","49193FL0070001","Smile for Health Child C80A80","49193FL007",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0090001","Smile for Health Child C60A70","49193FL009",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a70-ppo.pdf",,,,"49193FL0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","Individual","Yes","86-0307623","49193FL0010002","Smile for Health Family C60A70","49193FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0150001","Smile for Health Child C80A80","49193FL015",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c80a80-ppo.pdf",,,,"49193FL0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","Individual","Yes","86-0307623","49193FL0010002","Smile for Health Family C60A70","49193FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","Individual","Yes","86-0307623","49193FL0010001","Smile for Health Child C60A70","49193FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0150002","Smile for Health Family C80A80","49193FL015",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c80a80-ppo.pdf",,,,"49193FL0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","Individual","Yes","86-0307623","49193FL0010001","Smile for Health Child C60A70","49193FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","1","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0150002","Smile for Health Family C80A80","49193FL015",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c80a80-ppo.pdf",,,,"49193FL0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","2","49193","FL","Individual","Yes","86-0307623","49193FL0170001","Smile for Health Child C60","49193FL017",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes","https://secure.ucci.com/docs/summary-of-coverage-fl-idental.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental","https://secure.ucci.com/docs/plan-brochure-fl-idental.pdf",,"49193FL0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","2","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0120001","Smile for Health Child C60A50","49193FL012",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a50-ppo.pdf",,,,"49193FL0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","2","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0120001","Smile for Health Child C60A50","49193FL012",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a50-ppo.pdf",,,,"49193FL0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","2","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0120002","Smile for Health Family C60A50","49193FL012",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a50-ppo.pdf",,,,"49193FL0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","2","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0120002","Smile for Health Family C60A50","49193FL012",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a50-ppo.pdf",,,,"49193FL0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","3","49193","FL","Individual","Yes","86-0307623","49193FL0020001","Smile for Health Child C60A60","49193FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","3","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0190001","Smile for Health Child C60","49193FL019",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","3","49193","FL","Individual","Yes","86-0307623","49193FL0020001","Smile for Health Child C60A60","49193FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","3","49193","FL","Individual","Yes","86-0307623","49193FL0020002","Smile for Health Family C60A60","49193FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","3","49193","FL","Individual","Yes","86-0307623","49193FL0020002","Smile for Health Family C60A60","49193FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","4","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0200001","Smile for Health Child C80","49193FL020",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","4","49193","FL","Individual","Yes","86-0307623","49193FL0040001","Smile for Health Child C60A50","49193FL004",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","4","49193","FL","Individual","Yes","86-0307623","49193FL0040002","Smile For Health Family C60A50","49193FL004",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","Individual","Yes","86-0307623","49193FL0180001","Smile for Health Child C80","49193FL018",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0100001","Smile for Health Child C60A60","49193FL010",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a60-ppo.pdf",,,,"49193FL0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0100001","Smile for Health Child C60A60","49193FL010",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a60-ppo.pdf",,,,"49193FL0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","Individual","Yes","86-0307623","49193FL0180001","Smile for Health Child C80","49193FL018",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0180001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","5","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0100002","Smile for Health Family C60A60","49193FL010",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-family-c60a60-ppo.pdf",,,,"49193FL0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","Individual","Yes","86-0307623","49193FL0070001","Smile for Health Child C80A80","49193FL007",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-fl-idental",,,"49193FL0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","6","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0090001","Smile for Health Child C60A70","49193FL009",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-fl-grp-child-c60a70-ppo.pdf",,,,"49193FL0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","8","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0130001","Smile for Health Child C80A70","49193FL013",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","10","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0160001","Smile for Health Child C80A50","49193FL016",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","49193","HIOS","4","2013-09-10 14:43:20","10","49193","FL","SHOP (Small Group)","Yes","86-0307623","49193FL0160002","Smile for Health Family C80A50","49193FL016",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49193FL0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650002","Gold Premier BX Dade","51398FL065",,"FLN002","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650002/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650002","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650002-00","Standard Gold Off Exchange Plan","81.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,800","$0","$500","$0","$1,300","$0","$80","8"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650002","Gold Premier BX Dade","51398FL065",,"FLN002","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650002/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650002","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650002-01","Standard Gold On Exchange Plan","81.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,800","$0","$500","$0","$1,300","$0","$80","9"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650002","Gold Premier BX Dade","51398FL065",,"FLN002","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650002/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650002","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"10"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650002","Gold Premier BX Dade","51398FL065",,"FLN002","FLS001","FLF004","New","HMO","Gold","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650002/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650002","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650002-03","Limited Cost Sharing Plan Variation","81.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,800","$0","$500","$0","$1,300","$0","$80","11"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-00","Standard Silver Off Exchange Plan","72.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","62"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-01","Standard Silver On Exchange Plan","72.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","63"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-04","73% AV Level Silver Plan","74.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,600","$5,200","100%","$2,600","$5,200","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","100%","$100","$200","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$100","$1,300","$0","$80","66"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-05","87% AV Level Silver Plan","88.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,100","$4,200","$2,100","$4,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$400","$0","$500","$0","$1,200","$0","$80","67"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1320001","Gym Access IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610002","SMAG Essential Plus Gold HMO 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610002-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680003","SMAG Essential Plus Bronze POS with Pediatric Dental 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680003-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1220003","IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220003-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1220003","IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220003-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1220003","IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680004","Gym Access SMAG Essential Plus Bronze POS with Pediatric Dental 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680004-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1380004","Gym Access IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380004-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1150002","IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150002-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550002","SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550002-00","Standard Silver Off Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1150002","IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1150002","IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150002-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550002","SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550002-01","Standard Silver On Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630002","SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630002-00","Standard Silver Off Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1290001","IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290001-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630002","SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630002-01","Standard Silver On Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680004","Gym Access SMAG Essential Plus Bronze POS with Pediatric Dental 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680004-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1460004","Gym Access IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460004-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","8"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650012","Silver Deluxe AX Dade","51398FL065",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650012/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650012","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650012-06","94% AV Level Silver Plan","94.40%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$500","$0","$700","$0","$80","68"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-00","Standard Silver Off Exchange Plan","71.60%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","76"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-01","Standard Silver On Exchange Plan","71.60%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","77"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"78"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-03","Limited Cost Sharing Plan Variation","71.60%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,200","$8,400","100%","$4,200","$8,400","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","100%","$800","$1,600","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$800","$1,000","$0","$80","79"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650015","Silver Deluxe CX Dade","51398FL065",,"FLN002","FLS001","FLF002","New","HMO","Silver","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650015/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650015","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650015-04","73% AV Level Silver Plan","74.00%",,"No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$3,200","$6,400","$3,200","$6,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,600","$5,200","100%","$2,600","$5,200","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","100%","$100","$200","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,800","$0","$500","$100","$1,300","$0","$80","80"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650020","Bronze Select BX Dade","51398FL065",,"FLN002","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650020/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650020","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650020-00","Standard Bronze Off Exchange Plan","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","87"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650020","Bronze Select BX Dade","51398FL065",,"FLN002","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650020/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650020","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650020-01","Standard Bronze On Exchange Plan","61.80%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%","$6,350","$12,700","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$800","$1,400","$500","$1,500","$600","$0","$80","88"
"2014","FL","51398","HIOS","5","2014-01-21 08:29:49","1","51398","FL","Individual","No","59-1419293","51398FL0650020","Bronze Select BX Dade","51398FL065",,"FLN002","FLS001","FLF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialist providing services require a referral and pre-authorization determined by Preferred Medical Plan except the first five (5) dermatology outpatient visits, podiatry visits, chiropractic visits and one (1) annual wellness obstetrical/ gynecological exam.   All covered services will be subject to the Preferred Medical Services Contract.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","All eligible medical expenses for treatment, supplies, services and products will be determined in accordance with the Preferred Medical Plan Services Contract.  Repatriation of remains when death occurs outside the U.S. is specifically excluded.","No",,"No","http://www.pmpmarketplace.com/plans/51398FL0650020/sbc.pdf","http://www.pmpmarketplace.com/plans/payment","http://www.pmpmarketplace.com/plans/51398FL0650020","http://www.pmpmarketplace.com/plans/formulary.pdf","51398FL0650020-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"89"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-01","Standard Silver On Exchange Plan","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-05","87% AV Level Silver Plan","88.00%","0.879453003406525","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$600","$320","$80","8"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","2","54172","FL","Individual","No","26-0155137","54172FL0010002","Molina Marketplace Silver Plan","54172FL001",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9939",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/silver","54172FL0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","54172FL0010003-01","Standard Bronze On Exchange Plan","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","4"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","54172FL0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","54172","HIOS","6","2013-10-15 07:27:56","3","54172","FL","Individual","No","26-0155137","54172FL0010003","Molina Marketplace Bronze Plan","54172FL001",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/fl/en-us/hp/marketplace/plans/bronze","54172FL0010003-03","Limited Cost Sharing Plan Variation","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","23"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","24"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","18"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","19"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","20"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1380004","Gym Access IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1290001","IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290001-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1150004","Gym Access IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150004-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730003","SMAG Essential Plus Gold Value POS with Pediatric Dental 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730003-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1300001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600002","SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600002-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1310002","Gym Access IND Essential Plus Catastrophic HMO Partners 36","56503FL131","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1310002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680002","SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680002-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1310002","Gym Access IND Essential Plus Catastrophic HMO Partners 36","56503FL131","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1310002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1290001","IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290001-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1290001","IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600003","SMAG Essential Plus Bronze HMO with Pediatric Dental 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600003-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1150003","IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1460004","Gym Access IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460004-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550003","SMAG Essential Plus Silver HMO with Pediatric Dental 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550003-00","Standard Silver Off Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1220002","IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220002-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1220002","IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220002-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1220002","IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1070001","IND Essential Catastrophic HMO Partners 34","56503FL107","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1070001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550004","Gym Access SMAG Essential Plus Silver HMO with Pediatric Dental 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550004-00","Standard Silver Off Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1080002","IND Essential Catastrophic HMO 34","56503FL108","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1080002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1080002","IND Essential Catastrophic HMO 34","56503FL108","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1080002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550004","Gym Access SMAG Essential Plus Silver HMO with Pediatric Dental 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550004-01","Standard Silver On Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1090002","IND Essential Catastrophic POS 35","56503FL109","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1090002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630004","Gym Access SMAG Essential Plus Silver POS with Pediatric Dental 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630004-00","Standard Silver Off Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","Individual","No","26-3238817","56503FL1090002","IND Essential Catastrophic POS 35","56503FL109","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1090002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","1","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630004","Gym Access SMAG Essential Plus Silver POS with Pediatric Dental 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630004-01","Standard Silver On Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1070002","Gym Access IND Essential Catastrophic HMO Partners 34","56503FL107","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1070002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620002","SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620002-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1070002","Gym Access IND Essential Catastrophic HMO Partners 34","56503FL107","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1070002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620002","SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620002-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700002","SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700002-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1080001","Gym Access IND Essential Catastrophic HMO 34","56503FL108","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1080001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700002","SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700002-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1080001","Gym Access IND Essential Catastrophic HMO 34","56503FL108","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1080001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1090001","Gym Access IND Essential Catastrophic POS 35","56503FL109","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1090001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","2","56503","FL","Individual","No","26-3238817","56503FL1090001","Gym Access IND Essential Catastrophic POS 35","56503FL109","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1090001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690002","SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690002-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1300003","IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1300003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690002","SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690002-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1300003","IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1300003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1310001","IND Essential Plus Catastrophic HMO Partners 36","56503FL131","7265435496","FLN002","FLS002","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1310001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730002","SMAG Essential Plus Gold Value POS 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730002-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1320003","IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1320003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","3","56503","FL","Individual","No","26-3238817","56503FL1320003","IND Essential Plus Catastrophic POS 37","56503FL132","7265435496","FLN001","FLS001","FLF001","New","POS","Catastrophic","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1320003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$13,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"$13,500","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600002","SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600002-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","4","56503","FL","Individual","No","26-3238817","56503FL1300001","Gym Access IND Essential Plus Catastrophic HMO 36","56503FL130","7265435496","FLN001","FLS001","FLF001","New","HMO","Catastrophic","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1300001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,800","$200","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1220001","Gym Access IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220001-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1220001","Gym Access IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220001-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1150004","Gym Access IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730003","SMAG Essential Plus Gold Value POS with Pediatric Dental 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730003-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1460004","Gym Access IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","18"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","5","56503","FL","Individual","No","26-3238817","56503FL1220002","IND Essential Bronze POS 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220002-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620003","SMAG Essential Plus Platinum HMO with Pediatric Dental 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620003-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460002-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620004","Gym Access SMAG Essential Plus Platinum HMO with Pediatric Dental 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620004-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1150001","Gym Access IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150001-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620003","SMAG Essential Plus Platinum HMO with Pediatric Dental 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620003-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1150001","Gym Access IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150001-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1150001","Gym Access IND Essential Bronze HMO 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700003","SMAG Essential Plus Platinum POS with Pediatric Dental 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700003-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1290002","Gym Access IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290002-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1290002","Gym Access IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290002-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1290002","Gym Access IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","6","56503","FL","Individual","No","26-3238817","56503FL1290002","Gym Access IND Essential Bronze HMO Partners 39","56503FL129","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1290002-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1220004","Gym Access IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220004-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1220004","Gym Access IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220004-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1220004","Gym Access IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","7","56503","FL","Individual","No","26-3238817","56503FL1220004","Gym Access IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220004-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600003","SMAG Essential Plus Bronze HMO with Pediatric Dental 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600003-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1150003","IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150003-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1150003","IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150003-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680003","SMAG Essential Plus Bronze POS with Pediatric Dental 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680003-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1150003","IND Essential Bronze HMO with Pediatric Dental 39","56503FL115","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1150003-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","8","56503","FL","Individual","No","26-3238817","56503FL1220003","IND Essential Bronze POS with Pediatric Dental 40","56503FL122","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1220003-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610003","SMAG Essential Plus Gold HMO with Pediatric Dental 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610003-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380002-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610003","SMAG Essential Plus Gold HMO with Pediatric Dental 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610003-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380002-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550003","SMAG Essential Plus Silver HMO with Pediatric Dental 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550003-01","Standard Silver On Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1380002","IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380002-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1380004","Gym Access IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380004-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480001-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1400004","Gym Access IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400004-03","Limited Cost Sharing Plan Variation",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1480004","Gym Access IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480004-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","21"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","23","56503","FL","Individual","No","26-3238817","56503FL1160001","Gym Access IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160001-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470001-03","Limited Cost Sharing Plan Variation",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630003","SMAG Essential Plus Silver POS with Pediatric Dental 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630003-00","Standard Silver Off Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1540001","IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540001-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630003","SMAG Essential Plus Silver POS with Pediatric Dental 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630003-01","Standard Silver On Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1540001","IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540001-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1540001","IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1540001","IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540001-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460002-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460002-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","9","56503","FL","Individual","No","26-3238817","56503FL1460002","IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380001-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620004","Gym Access SMAG Essential Plus Platinum HMO with Pediatric Dental 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620004-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380001-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700004","Gym Access SMAG Essential Plus Platinum POS with Pediatric Dental 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700004-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700004","Gym Access SMAG Essential Plus Platinum POS with Pediatric Dental 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700004-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1380001","Gym Access IND Essential Plus Bronze HMO 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380001-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1540002","Gym Access IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540002-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1540002","Gym Access IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540002-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1540002","Gym Access IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1540002","Gym Access IND Essential Plus Bronze HMO Partners 41","56503FL154","7265435496","FLN002","FLS002","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1540002-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460001-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460001-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","10","56503","FL","Individual","No","26-3238817","56503FL1460001","Gym Access IND Essential Plus Bronze POS 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460001-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1380003","IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380003-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690004","Gym Access SMAG Essential Plus Gold POS with Pediatric Dental 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690004-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1380003","IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380003-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690004","Gym Access SMAG Essential Plus Gold POS with Pediatric Dental 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690004-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1380003","IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730004","Gym Access SMAG Essential Plus Gold Value POS with Pediatric Dental 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730004-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,100","$100","$500","$0","$1,100","$500","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1380003","IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380003-03","Limited Cost Sharing Plan Variation",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730004","Gym Access SMAG Essential Plus Gold Value POS with Pediatric Dental 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730004-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,100","$100","$500","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1460003","IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460003-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1460003","IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460003-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1460003","IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","11","56503","FL","Individual","No","26-3238817","56503FL1460003","IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460003-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1380004","Gym Access IND Essential Plus Bronze HMO with Pediatric Dental 41","56503FL138","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1380004-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600004","Gym Access SMAG Essential Plus Bronze HMO with Pediatric Dental 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600004-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1240001","IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240001-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","18"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","19"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","20"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","21"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","22"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","23"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","24"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","35","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","35","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390001-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","7"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","5","57451","FL","Individual","No","65-0986441","57451FL0070005","Catastrophic 100% HMO Carelink","57451FL007",,"FLN001","FLS001","FLF004","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72618","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$200","$5,000","$60","$0","$40","4"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","5","57451","FL","Individual","No","65-0986441","57451FL0080005","Catastrophic 100% HMO","57451FL008",,"FLN002","FLS002","FLF004","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72619","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$200","$5,000","$60","$0","$40","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1330003","IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330003-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1330002","IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330002-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","12","56503","FL","Individual","No","26-3238817","56503FL1460004","Gym Access IND Essential Plus Bronze POS with Pediatric Dental 42","56503FL146","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1460004-03","Limited Cost Sharing Plan Variation",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620001-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1620001","Gym Access SMAG Essential Plus Platinum HMO 65","56503FL162","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1620001-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700001","Gym Access SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700001-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1700001","Gym Access SMAG Essential Plus Platinum POS 66","56503FL170","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1700001-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1100002","Individual Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100002-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","22"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1330001","Gym Access IND Essential Plus Silver HMO 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330001-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","22","56503","FL","Individual","No","26-3238817","56503FL1160002","IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160002-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","22","56503","FL","Individual","No","26-3238817","56503FL1160002","IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1490002","Gym Access IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490002-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","23","56503","FL","Individual","No","26-3238817","56503FL1160001","Gym Access IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160001-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","20"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","21"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","22"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","23"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","13","56503","FL","Individual","No","26-3238817","56503FL1170002","IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170002-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","24"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690001","Gym Access SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690001-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1690001","Gym Access SMAG Essential Plus Gold POS 64","56503FL169","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1690001-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730001","Gym Access SMAG Essential Plus Gold Value POS 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730001-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,100","$100","$500","$0","$1,100","$500","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1100001","Gym Access IND Essential Silver HMO 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100001-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1730001","Gym Access SMAG Essential Plus Gold Value POS 69","56503FL173","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1730001-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,100","$100","$500","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1240002","Gym Access IND Essential Silver HMO Partners 43","56503FL124","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1240002-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","21"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","22"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","23"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","14","56503","FL","Individual","No","26-3238817","56503FL1170001","Gym Access IND Essential Silver POS 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170001-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","24"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600001-00","Standard Bronze Off Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1600001","Gym Access SMAG Essential Plus Bronze HMO 41","56503FL160","7265435496","FLN001","FLS001","FLF001","New","HMO","Bronze","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1600001-01","Standard Bronze On Exchange Plan",,"0.608597338199615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","60%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$50","$1,400","$0","$4,500","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680001-00","Standard Bronze Off Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1680001","Gym Access SMAG Essential Plus Bronze POS 42","56503FL168","7265435496","FLN001","FLS001","FLF001","New","POS","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1680001-01","Standard Bronze On Exchange Plan",,"0.608909845352173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","55%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,500","$50","$1,300","$0","$4,500","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1100003","IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100003-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","15","56503","FL","Individual","No","26-3238817","56503FL1170003","IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170003-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610001","Gym Access SMAG Essential Plus Gold HMO 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610001-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1610001","Gym Access SMAG Essential Plus Gold HMO 63","56503FL161","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1610001-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550001","Gym Access SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550001-00","Standard Silver Off Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1550001","Gym Access SMAG Essential Plus Silver HMO 53","56503FL155","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1550001-01","Standard Silver On Exchange Plan",,"0.702355802059174","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$2,300","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1480003","IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480003-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","29","56503","FL","Individual","No","26-3238817","56503FL1230004","Gym Access IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230004-03","Limited Cost Sharing Plan Variation",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470002-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470002-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1720003","IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720003-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1720003","IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720003-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630001","Gym Access SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630001-00","Standard Silver Off Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-05","87% AV Level Silver Plan",,"0.865751326084137","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$800","$0","$400","$400","$700","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","SHOP (Small Group)","No","26-3238817","56503FL1630001","Gym Access SMAG Essential Plus Silver POS 54","56503FL163","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1630001-01","Standard Silver On Exchange Plan",,"0.709819197654724","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$1,600","$0","$2,200","$200","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1100004","Gym Access IND Essential Silver HMO with Pediatric Dental 43","56503FL110","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1100004-06","94% AV Level Silver Plan",,"0.930559694766998","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","16","56503","FL","Individual","No","26-3238817","56503FL1170004","Gym Access IND Essential Silver POS with Pediatric Dental 44","56503FL117","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1170004-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-00","Standard Silver Off Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1490001","IND Essential Plus Silver HMO Partners 53","56503FL149","7265435496","FLN002","FLS002","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1490001-01","Standard Silver On Exchange Plan",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","19"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","17","56503","FL","Individual","No","26-3238817","56503FL1410002","IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","20"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-00","Standard Silver Off Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","18"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","18","56503","FL","Individual","No","26-3238817","56503FL1410001","Gym Access IND Essential Plus Silver POS 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410001-01","Standard Silver On Exchange Plan",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","19"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","19","56503","FL","Individual","No","26-3238817","56503FL1410003","IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410003-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","25","56503","FL","Individual","No","26-3238817","56503FL1160004","Gym Access IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160004-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","26","56503","FL","Individual","No","26-3238817","56503FL1230002","IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230002-00","Standard Gold Off Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","26","56503","FL","Individual","No","26-3238817","56503FL1230002","IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230002-01","Standard Gold On Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","26","56503","FL","Individual","No","26-3238817","56503FL1230002","IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","26","56503","FL","Individual","No","26-3238817","56503FL1230002","IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230002-03","Limited Cost Sharing Plan Variation",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","27","56503","FL","Individual","No","26-3238817","56503FL1230001","Gym Access IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230001-00","Standard Gold Off Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","36","56503","FL","Individual","No","26-3238817","56503FL1390003","IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390003-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","37","56503","FL","Individual","No","26-3238817","56503FL1390004","Gym Access IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390004-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","37","56503","FL","Individual","No","26-3238817","56503FL1390004","Gym Access IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390004-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","37","56503","FL","Individual","No","26-3238817","56503FL1390004","Gym Access IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","37","56503","FL","Individual","No","26-3238817","56503FL1390004","Gym Access IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390004-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400002-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","28","56503","FL","Individual","No","26-3238817","56503FL1230003","IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230003-03","Limited Cost Sharing Plan Variation",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","29","56503","FL","Individual","No","26-3238817","56503FL1230004","Gym Access IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230004-00","Standard Gold Off Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","29","56503","FL","Individual","No","26-3238817","56503FL1230004","Gym Access IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230004-01","Standard Gold On Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","29","56503","FL","Individual","No","26-3238817","56503FL1230004","Gym Access IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480002-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480002-03","Limited Cost Sharing Plan Variation",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400001-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1400003","IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400003-03","Limited Cost Sharing Plan Variation",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-03","Limited Cost Sharing Plan Variation",,"0.699878931045532","No","No","No","100%",,"$3,950","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$2,200","$0","$1,100","$200","$500","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1330004","Gym Access IND Essential Plus Silver HMO with Pediatric Dental 53","56503FL133","7265435496","FLN001","FLS001","FLF001","New","HMO","Silver","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1330004-04","73% AV Level Silver Plan",,"0.727572679519653","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,650","$3,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,700","$0","$1,000","$200","$500","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","13"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-03","Limited Cost Sharing Plan Variation",,"0.693996667861938","No","No","No","100%",,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,200","$0","$1,400","$0","$2,200","$200","$0","$0","14"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-04","73% AV Level Silver Plan",,"0.738668143749237","No","No","No","100%",,"$3,400","$6,800",,,"$6,800","$13,600","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,700","$3,400","30%",,,,"$3,400","$6,800","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$1,500","$0","$1,800","$200","$40","$0","15"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-05","87% AV Level Silver Plan",,"0.872972667217255","No","No","No","100%",,"$1,000","$2,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$400","$0","$700","$0","$400","$200","$500","$0","16"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","20","56503","FL","Individual","No","26-3238817","56503FL1410004","Gym Access IND Essential Plus Silver POS with Pediatric Dental 54","56503FL141","7265435496","FLN001","FLS001","FLF001","New","POS","Silver","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1410004-06","94% AV Level Silver Plan",,"0.934227645397186","No","No","No","100%",,"$500","$1,000",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$30","$400","$0","$70","$400","$400","$0","17"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","22","56503","FL","Individual","No","26-3238817","56503FL1160002","IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160002-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","22","56503","FL","Individual","No","26-3238817","56503FL1160002","IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160002-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1720001","Gym Access IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720001-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1720001","Gym Access IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720001-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1720001","Gym Access IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1720001","Gym Access IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720001-03","Limited Cost Sharing Plan Variation",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1470003","IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470003-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1470003","IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470003-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1470003","IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400001-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1400001","Gym Access IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400001-03","Limited Cost Sharing Plan Variation",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","23","56503","FL","Individual","No","26-3238817","56503FL1160001","Gym Access IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","23","56503","FL","Individual","No","26-3238817","56503FL1160001","Gym Access IND Essential Gold HMO 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160001-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-05","87% AV Level Silver Plan",,"0.878752827644348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","24","56503","FL","Individual","No","26-3238817","56503FL1160003","IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160003-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","24","56503","FL","Individual","No","26-3238817","56503FL1160003","IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160003-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","24","56503","FL","Individual","No","26-3238817","56503FL1160003","IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","24","56503","FL","Individual","No","26-3238817","56503FL1160003","IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160003-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","25","56503","FL","Individual","No","26-3238817","56503FL1160004","Gym Access IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160004-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","25","56503","FL","Individual","No","26-3238817","56503FL1160004","Gym Access IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160004-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,300","$0","$700","$400","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","25","56503","FL","Individual","No","26-3238817","56503FL1160004","Gym Access IND Essential Gold HMO with Pediatric Dental 67","56503FL116","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1160004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","27","56503","FL","Individual","No","26-3238817","56503FL1230001","Gym Access IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230001-01","Standard Gold On Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","27","56503","FL","Individual","No","26-3238817","56503FL1230001","Gym Access IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","27","56503","FL","Individual","No","26-3238817","56503FL1230001","Gym Access IND Essential Gold POS 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,"Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.  Also adult and childhood dental check-ups, basic dental care, major dental care and orthodontia are excluded from this plan","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230001-03","Limited Cost Sharing Plan Variation",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","28","56503","FL","Individual","No","26-3238817","56503FL1230003","IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230003-00","Standard Gold Off Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","28","56503","FL","Individual","No","26-3238817","56503FL1230003","IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230003-01","Standard Gold On Exchange Plan",,"0.792550504207611","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","28","56503","FL","Individual","No","26-3238817","56503FL1230003","IND Essential Gold POS with Pediatric Dental 68","56503FL123","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.","Allergy Testing, Dialysis, Infusion Therapy, Prosthetic Devices are not covered.","0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1230003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1470002","IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470002-03","Limited Cost Sharing Plan Variation",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1720002","IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720002-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1720002","IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720002-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1720002","IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","30","56503","FL","Individual","No","26-3238817","56503FL1720002","IND Essential Plus Gold Value POS 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720002-03","Limited Cost Sharing Plan Variation",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470001-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470001-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","31","56503","FL","Individual","No","26-3238817","56503FL1470001","Gym Access IND Essential Plus Gold POS 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480001-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","40","56503","FL","Individual","No","26-3238817","56503FL1480001","Gym Access IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480001-03","Limited Cost Sharing Plan Variation",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1400003","IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400003-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1400003","IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400003-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1400003","IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1470003","IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470003-03","Limited Cost Sharing Plan Variation",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1720003","IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","32","56503","FL","Individual","No","26-3238817","56503FL1720003","IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720003-03","Limited Cost Sharing Plan Variation",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010013","Ambetter Bronze 4","86382FL001",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","3","86382","FL","Individual","No","20-8937577","86382FL0010008","Ambetter Silver 4","86382FL001",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-06","94% AV Level Silver Plan",,"0.948886394500732","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020007","Ambetter Silver 3 + Vision","86382FL002",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1470004","Gym Access IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470004-00","Standard Gold Off Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1470004","Gym Access IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470004-01","Standard Gold On Exchange Plan",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","5"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-05","87% AV Level Silver Plan","87.00%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250","$0","$200","$0","$2,100","$0","$40","14"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-06","94% AV Level Silver Plan","93.10%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,500","$0","$40","15"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0070003","Bronze $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070003-01","Standard Bronze On Exchange Plan","62.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","$1,000","$0","$200","$1,500","$2,400","$0","$40","4"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0070003","Bronze $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0070003","Bronze $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070003-03","Limited Cost Sharing Plan Variation","62.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","$1,000","$0","$200","$1,500","$2,400","$0","$40","6"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0080003","Bronze $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72615","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080003-01","Standard Bronze On Exchange Plan","62.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","$1,000","$0","$200","$1,500","$2,400","$0","$40","7"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0080003","Bronze $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72615","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","3","57451","FL","Individual","No","65-0986441","57451FL0080003","Bronze $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF003","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72615","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080003-03","Limited Cost Sharing Plan Variation","62.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","$1,000","$0","$200","$1,500","$2,400","$0","$40","9"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Bronze Deductible Only HMO HSA Eligible Carelink","57451FL007",,"FLN001","FLS001","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72630","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","4"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Bronze Deductible Only HMO HSA Eligible Carelink","57451FL007",,"FLN001","FLS001","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72630","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1470004","Gym Access IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1470004","Gym Access IND Essential Plus Gold POS with Pediatric Dental 64","56503FL147","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1470004-03","Limited Cost Sharing Plan Variation",,"0.80064070224762","No","No","No","100%",,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","10%",,,,"$3,200","$6,400","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$100","$300","$0","$1,100","$500","$0","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1720004","Gym Access IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720004-00","Standard Gold Off Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1720004","Gym Access IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720004-01","Standard Gold On Exchange Plan",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1720004","Gym Access IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","33","56503","FL","Individual","No","26-3238817","56503FL1720004","Gym Access IND Essential Plus Gold Value POS with Pediatric Dental 69","56503FL172","7265435496","FLN001","FLS001","FLF001","New","POS","Gold","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1720004-03","Limited Cost Sharing Plan Variation",,"0.801670432090759","No","No","No","100%",,"$3,000","$6,000",,,"$5,800","$11,600","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","15%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$100","$500","$0","$1,100","$500","$0","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","34","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390002-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","34","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390002-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","34","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","34","56503","FL","Individual","No","26-3238817","56503FL1390002","IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390002-03","Limited Cost Sharing Plan Variation",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","35","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390001-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","35","56503","FL","Individual","No","26-3238817","56503FL1390001","Gym Access IND Essential Plus Gold HMO 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390001-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","36","56503","FL","Individual","No","26-3238817","56503FL1390003","IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390003-00","Standard Gold Off Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","4"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","36","56503","FL","Individual","No","26-3238817","56503FL1390003","IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390003-01","Standard Gold On Exchange Plan",,"0.800574660301209","No","No","No","100%",,"$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$50","$1,300","$0","$800","$200","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","36","56503","FL","Individual","No","26-3238817","56503FL1390003","IND Essential Plus Gold HMO with Pediatric Dental 63","56503FL139","7265435496","FLN001","FLS001","FLF001","New","HMO","Gold","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1390003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400002-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1400002","IND Essential Plus Platinum HMO 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's PCP will refer to all specialists, except those listed as ""Direct Access"" specialists.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400002-03","Limited Cost Sharing Plan Variation",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","7"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","39","56503","FL","Individual","No","26-3238817","56503FL1480002","IND Essential Plus Platinum POS 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480002-00","Standard Platinum Off Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","8"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1480003","IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480003-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1480003","IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","41","56503","FL","Individual","No","26-3238817","56503FL1480003","IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480003-03","Limited Cost Sharing Plan Variation",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","11"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1400004","Gym Access IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400004-00","Standard Platinum Off Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010009","Ambetter Silver 5","86382FL001",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010013","Ambetter Bronze 4","86382FL001",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1400004","Gym Access IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400004-01","Standard Platinum On Exchange Plan",,"0.903126001358032","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$0","$0","$500","$200","$0","5"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","Individual","Yes","65-0743731","59667FL0010002","DentaQuest Dental Plan Pediatric Low","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020002","DentaQuest Dental Plan Pediatric Low","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0020002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest Dental Plan Family High","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","www.dentaquest.com","www.dentaquest.com","www.dentaquest.com",,"59667FL0020003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","Individual","Yes","65-0743731","59667FL0010003","DentaQuest Dental Plan Family High","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","Individual","Yes","65-0743731","59667FL0010003","DentaQuest Dental Plan Family High","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020003","DentaQuest Dental Plan Family High","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","www.dentaquest.com","www.dentaquest.com","www.dentaquest.com",,"59667FL0020003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","Individual","Yes","65-0743731","59667FL0010004","DentaQuest Dental Plan Family Low","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest Dental Plan Family Low","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","www.dentaquest.com","www.dentaquest.com","www.dentaquest.com",,"59667FL0020004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","Individual","Yes","65-0743731","59667FL0010004","DentaQuest Dental Plan Family Low","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","2","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020004","DentaQuest Dental Plan Family Low","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","www.dentaquest.com","www.dentaquest.com","www.dentaquest.com",,"59667FL0020004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010002","Ambetter Gold 2","86382FL001",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010002","Ambetter Gold 2","86382FL001",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1400004","Gym Access IND Essential Plus Platinum HMO with Pediatric Dental 65","56503FL140","7265435496","FLN001","FLS001","FLF001","New","HMO","Platinum","No","Both","No","Yes","The member's medical or dental PCP will refer to all medical and dental specialists, except those listed as ""Direct Access"" medical or dental providers.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"5","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1400004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$0","6"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1480004","Gym Access IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480004-01","Standard Platinum On Exchange Plan",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","9"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1480004","Gym Access IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010007","Ambetter Silver 3","86382FL001",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","FL","56503","HIOS","6","2014-03-19 07:06:49","42","56503","FL","Individual","No","26-3238817","56503FL1480004","Gym Access IND Essential Plus Platinum POS with Pediatric Dental 66","56503FL148","7265435496","FLN001","FLS001","FLF001","New","POS","Platinum","No","Both","No","Yes","MEDICAL services do NOT require a referral.  However, in order to be covered by FHCP, DENTAL or ORTHODONTIA specialty services must be requested by the Member's Dental PCP, and FHCP pre-authorize all specialty dental care.",,"0","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care only, unless pre-authorized by Issuer.","Yes","http://www.fhcp.com/individual-plans/","www.fhcp.com","www.fhcp.com","http://www.fhcp.com/individual-plans/","56503FL1480004-03","Limited Cost Sharing Plan Variation",,"0.902972877025604","No","No","No","100%",,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","15%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$400","$0","$0","$500","$200","$0","11"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0070001","Gold $5 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070001-01","Standard Gold On Exchange Plan","78.30%","0.740367293357849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$200","$200","$250","$1,700","$0","$40","4"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0070001","Gold $5 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0070001","Gold $5 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070001-03","Limited Cost Sharing Plan Variation","78.30%","0.740367293357849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$200","$200","$250","$1,700","$0","$40","6"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0080001","Gold $5 Copay HMO","57451FL008",,"FLN002","FLS002","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080001-01","Standard Gold On Exchange Plan","78.30%","0.740367293357849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$200","$200","$250","$1,700","$0","$40","7"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0080001","Gold $5 Copay HMO","57451FL008",,"FLN002","FLS002","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","1","57451","FL","Individual","No","65-0986441","57451FL0080001","Gold $5 Copay HMO","57451FL008",,"FLN002","FLS002","FLF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080001-03","Limited Cost Sharing Plan Variation","78.30%","0.740367293357849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$200","$200","$250","$1,700","$0","$40","9"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-01","Standard Silver On Exchange Plan","69.90%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","4"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-03","Limited Cost Sharing Plan Variation","69.90%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","6"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-04","73% AV Level Silver Plan","74.00%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","7"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-05","87% AV Level Silver Plan","87.00%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250","$0","$200","$0","$2,100","$0","$40","8"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0070002","Silver $10 Copay HMO Carelink","57451FL007",,"FLN001","FLS001","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72604","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070002-06","94% AV Level Silver Plan","93.10%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,500","$0","$40","9"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-01","Standard Silver On Exchange Plan","69.90%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","10"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","11"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-03","Limited Cost Sharing Plan Variation","69.90%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","12"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","2","57451","FL","Individual","No","65-0986441","57451FL0080002","Silver $10 Copay HMO","57451FL008",,"FLN002","FLS002","FLF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080002-04","73% AV Level Silver Plan","74.00%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$300","$200","$1,200","$2,300","$0","$40","13"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0070004","Bronze Deductible Only HMO HSA Eligible Carelink","57451FL007",,"FLN001","FLS001","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72630","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0070004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","6"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0080004","Bronze Deductible Only HMO HSA Eligible","57451FL008",,"FLN002","FLS002","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72631","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","7"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0080004","Bronze Deductible Only HMO HSA Eligible","57451FL008",,"FLN002","FLS002","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72631","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","FL","57451","HIOS","4","2013-10-15 07:27:56","4","57451","FL","Individual","No","65-0986441","57451FL0080004","Bronze Deductible Only HMO HSA Eligible","57451FL008",,"FLN002","FLS002","FLF004","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All","Refer to the Individual Member Contract","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/fl72631","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmochcfl","www.c1formularyhix.com","57451FL0080004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","9"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","Individual","Yes","65-0743731","59667FL0010001","DentaQuest Dental Plan Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020001","DentaQuest Dental Plan Pediatric High","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0020001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","Individual","Yes","65-0743731","59667FL0010001","DentaQuest Dental Plan Pediatric High","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-03","Limited Cost Sharing Plan Variation","69.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-04","73% AV Level Silver Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-05","87% AV Level Silver Plan","87.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-06","94% AV Level Silver Plan","93.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,200","$2,400","$1,800","$3,600","$300","$600","30%",,,,"$600","$1,200","$900","$1,800","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","Individual","No","45-3131932","77150FL0460001","IND Choice Gold 90 1500","77150FL046",,"FLN001","FLS001","FLF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986833307629612",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0460001-00","Standard Gold Off Exchange Plan","78.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0560001","SG Choice Gold 50 500","77150FL056",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988867395714413",,,"0","0","0","2014-01-01",,"Yes","Emergency and  Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0560001-00","Standard Gold Off Exchange Plan","78.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","50%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","Individual","No","45-3131932","77150FL0460001","IND Choice Gold 90 1500","77150FL046",,"FLN001","FLS001","FLF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986833307629612",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0460001-01","Standard Gold On Exchange Plan","78.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0560001","SG Choice Gold 50 500","77150FL056",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988867395714413",,,"0","0","0","2014-01-01",,"Yes","Emergency and  Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0560001-01","Standard Gold On Exchange Plan","78.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","50%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","Individual","No","45-3131932","77150FL0460001","IND Choice Gold 90 1500","77150FL046",,"FLN001","FLS001","FLF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986833307629612",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0460001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","6","77150","FL","Individual","No","45-3131932","77150FL0460001","IND Choice Gold 90 1500","77150FL046",,"FLN001","FLS001","FLF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986833307629612",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0460001-03","Limited Cost Sharing Plan Variation","78.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","Individual","No","45-3131932","77150FL0470001","IND Choice Gold 80 1500 Flex","77150FL047",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985514316488221",,,"0","0","4","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0470001-00","Standard Gold Off Exchange Plan","80.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0570001","SG Choice Gold 50 1000","77150FL057",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988616115833529",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0570001-00","Standard Gold Off Exchange Plan","78.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","Individual","No","45-3131932","77150FL0470001","IND Choice Gold 80 1500 Flex","77150FL047",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985514316488221",,,"0","0","4","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0470001-01","Standard Gold On Exchange Plan","80.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0570001","SG Choice Gold 50 1000","77150FL057",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.988616115833529",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0570001-01","Standard Gold On Exchange Plan","78.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","Individual","No","45-3131932","77150FL0470001","IND Choice Gold 80 1500 Flex","77150FL047",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985514316488221",,,"0","0","4","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0470001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020001","DentaQuest Dental Plan Pediatric High","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0020001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","Individual","Yes","65-0743731","59667FL0010002","DentaQuest Dental Plan Pediatric Low","59667FL001","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0010002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","59667","HIOS","5","2013-08-30 07:44:10","1","59667","FL","SHOP (Small Group)","Yes","65-0743731","59667FL0020002","DentaQuest Dental Plan Pediatric Low","59667FL002","7891798028","FLN001","FLS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/fl","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/fl",,"59667FL0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010005","Ambetter Silver 1","86382FL001",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0510001","SG Choice Silver 90 2500","77150FL051",,"FLN001","FLS001","FLF013","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986119671432833",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0510001-00","Standard Silver Off Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","Individual","No","45-3131932","77150FL0290001","IND Choice Bronze 80 5000","77150FL029",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977838087874946",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0290001-00","Standard Bronze Off Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0510001","SG Choice Silver 90 2500","77150FL051",,"FLN001","FLS001","FLF013","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.986119671432833",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0510001-01","Standard Silver On Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","Individual","No","45-3131932","77150FL0290001","IND Choice Bronze 80 5000","77150FL029",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977838087874946",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0290001-01","Standard Bronze On Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"5"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020002","Ambetter Gold 2 + Vision","86382FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020002","Ambetter Gold 2 + Vision","86382FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020002-03","Limited Cost Sharing Plan Variation",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020005","Ambetter Silver 1 + Vision","86382FL002",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020005-05","87% AV Level Silver Plan",,"0.879959166049957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-05","87% AV Level Silver Plan","87.97%","0.879661560058594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020009","Ambetter Silver 5 + Vision","86382FL002",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020004","Ambetter Gold 4 + Vision","86382FL002",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020004","Ambetter Gold 4 + Vision","86382FL002",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","Individual","No","45-3131932","77150FL0290001","IND Choice Bronze 80 5000","77150FL029",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977838087874946",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0290001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","1","77150","FL","Individual","No","45-3131932","77150FL0290001","IND Choice Bronze 80 5000","77150FL029",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.977838087874946",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject to Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0290001-03","Limited Cost Sharing Plan Variation","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","Individual","No","45-3131932","77150FL0300001","IND Choice Bronze 80 4000","77150FL030",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978938894943385",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0300001-00","Standard Bronze Off Exchange Plan","61.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","1","86382","FL","Individual","No","20-8937577","86382FL0010002","Ambetter Gold 2","86382FL001",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010004","Ambetter Gold 4","86382FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010004","Ambetter Gold 4","86382FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010004","Ambetter Gold 4","86382FL001",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010010","Ambetter Bronze 1","86382FL001",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010010","Ambetter Bronze 1","86382FL001",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010010","Ambetter Bronze 1","86382FL001",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010012","Ambetter Bronze 3","86382FL001",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0520001","SG Choice Silver 50 2000","77150FL052",,"FLN001","FLS001","FLF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985974558841475",,,"0","0","0","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0520001-00","Standard Silver Off Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","50%",,,,"$4,000","$12,000","$6,000","$18,000","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","Individual","No","45-3131932","77150FL0300001","IND Choice Bronze 80 4000","77150FL030",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978938894943385",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0300001-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"5"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020012","Ambetter Bronze 3 + Vision","86382FL002",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020012","Ambetter Bronze 3 + Vision","86382FL002",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020012","Ambetter Bronze 3 + Vision","86382FL002",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020013","Ambetter Bronze 4 + Vision","86382FL002",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020013","Ambetter Bronze 4 + Vision","86382FL002",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020013","Ambetter Bronze 4 + Vision","86382FL002",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030002","Ambetter Gold 2 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030002-01","Standard Gold On Exchange Plan",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030002","Ambetter Gold 2 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030002","Ambetter Gold 2 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030002-03","Limited Cost Sharing Plan Variation",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-05","87% AV Level Silver Plan",,"0.879959166049957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030005","Ambetter Silver 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030005-06","94% AV Level Silver Plan",,"0.948886394500732","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0520001","SG Choice Silver 50 2000","77150FL052",,"FLN001","FLS001","FLF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985974558841475",,,"0","0","0","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0520001-01","Standard Silver On Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","50%",,,,"$4,000","$12,000","$6,000","$18,000","$200","$400","50%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","Individual","No","45-3131932","77150FL0300001","IND Choice Bronze 80 4000","77150FL030",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978938894943385",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0300001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","2","77150","FL","Individual","No","45-3131932","77150FL0300001","IND Choice Bronze 80 4000","77150FL030",,"FLN001","FLS001","FLF014","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.978938894943385",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0300001-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","3","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0530001","SG Choice Gold 80 750","77150FL053",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989560931370072",,,"0","0","0","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0530001-00","Standard Gold Off Exchange Plan","80.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$750","$1,500","20%",,,,"$1,500","$3,000","$2,250","$4,500","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","3","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0530001","SG Choice Gold 80 750","77150FL053",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989560931370072",,,"0","0","0","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0530001-01","Standard Gold On Exchange Plan","80.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$750","$1,500","20%",,,,"$1,500","$3,000","$2,250","$4,500","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0540001","SG Choice Gold 80 1500","77150FL054",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989447333318982",,,"0","0","0","2014-01-01",,"Yes","Emergeny and urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0540001-00","Standard Gold Off Exchange Plan","78.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-00","Standard Silver Off Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0540001","SG Choice Gold 80 1500","77150FL054",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989447333318982",,,"0","0","0","2014-01-01",,"Yes","Emergeny and urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0540001-01","Standard Gold On Exchange Plan","78.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$9,000",,,"$9,000","$18,000","$13,000","$27,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-05","87% AV Level Silver Plan","86.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","$3,750","$7,500","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"9"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","4","77150","FL","Individual","No","45-3131932","77150FL0380001","IND Choice Silver 24","77150FL038",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985367938087952",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0380001-06","94% AV Level Silver Plan","94.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","$1,500","$3,000","$200","$400","20%",,,,"$400","$800","$600","$1,200","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"10"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0550001","SG Choice Gold 80 3000","77150FL055",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989506021515153",,,"0","0","0","2014-01-01",,"Yes","Emergency and urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0550001-00","Standard Gold Off Exchange Plan","79.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,400","$12,800","$9,600","$19,200","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-00","Standard Silver Off Exchange Plan","69.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","SHOP (Small Group)","No","45-3131932","77150FL0550001","SG Choice Gold 80 3000","77150FL055",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.989506021515153",,,"0","0","0","2014-01-01",,"Yes","Emergency and urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstInsurance.org/MPS",,"www.HealthFirstInsurance.org/MPS","www.healthfirstinsurance.org","77150FL0550001-01","Standard Gold On Exchange Plan","79.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,400","$12,800","$9,600","$19,200","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-01","Standard Silver On Exchange Plan","69.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","5","77150","FL","Individual","No","45-3131932","77150FL0420001","IND Choice Silver 34","77150FL042",,"FLN001","FLS001","FLF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985555337263931",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0420001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","7","77150","FL","Individual","No","45-3131932","77150FL0470001","IND Choice Gold 80 1500 Flex","77150FL047",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985514316488221",,,"0","0","4","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0470001-03","Limited Cost Sharing Plan Variation","80.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","8","77150","FL","Individual","No","45-3131932","77150FL0480001","IND Choice Gold 80 1000 Flex","77150FL048",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985562774493678",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0480001-00","Standard Gold Off Exchange Plan","81.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$10,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","8","77150","FL","Individual","No","45-3131932","77150FL0480001","IND Choice Gold 80 1000 Flex","77150FL048",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985562774493678",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0480001-01","Standard Gold On Exchange Plan","81.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$10,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","8","77150","FL","Individual","No","45-3131932","77150FL0480001","IND Choice Gold 80 1000 Flex","77150FL048",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985562774493678",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0480001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","8","77150","FL","Individual","No","45-3131932","77150FL0480001","IND Choice Gold 80 1000 Flex","77150FL048",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.985562774493678",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0480001-03","Limited Cost Sharing Plan Variation","81.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$10,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","9","77150","FL","Individual","No","45-3131932","77150FL0490001","IND Choice Gold 80 1000 6400 Flex","77150FL049",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98652023389165",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0490001-00","Standard Gold Off Exchange Plan","79.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","9","77150","FL","Individual","No","45-3131932","77150FL0490001","IND Choice Gold 80 1000 6400 Flex","77150FL049",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98652023389165",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0490001-01","Standard Gold On Exchange Plan","79.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"5"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","9","77150","FL","Individual","No","45-3131932","77150FL0490001","IND Choice Gold 80 1000 6400 Flex","77150FL049",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98652023389165",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0490001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","9","77150","FL","Individual","No","45-3131932","77150FL0490001","IND Choice Gold 80 1000 6400 Flex","77150FL049",,"FLN001","FLS001","FLF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.98652023389165",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0490001-03","Limited Cost Sharing Plan Variation","79.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$400","30%",,,,"$200","$400","$200","$400",,,,,,,,,,,,,,,,,,,"7"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","10","77150","FL","Individual","No","45-3131932","77150FL0500001","IND Choice Castrophic","77150FL050",,"FLN001","FLS001","FLF012","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.97698402397747",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0500001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"4"
"2014","FL","77150","HIOS","9","2014-03-19 07:06:49","10","77150","FL","Individual","No","45-3131932","77150FL0500001","IND Choice Castrophic","77150FL050",,"FLN001","FLS001","FLF012","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"0.97698402397747",,,"0","0","3","2014-01-01",,"Yes","Emergeny and Urgent Care Only","Yes","All covered services subject for Copays and Coinsurance","No","www.HealthFirstIndividual.org/MPI",,"www.HealthFirstIndividual.org/MPI","www.healthfirstinsurance.org","77150FL0500001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"5"
"2014","FL","85543","HIOS","3","2013-08-30 07:44:10","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010001","DentalConnect�","85543FL001",,"FLN001","FLS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"85543FL0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","85543","HIOS","3","2013-08-30 07:44:10","1","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010002","DentalConnect�","85543FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.47",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"85543FL0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","85543","HIOS","3","2013-08-30 07:44:10","2","85543","FL","SHOP (Small Group)","Yes","35-0472300","85543FL0010003","DentalConnect�","85543FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"85543FL0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010012","Ambetter Bronze 3","86382FL001",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010012","Ambetter Bronze 3","86382FL001",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","2","86382","FL","Individual","No","20-8937577","86382FL0010013","Ambetter Bronze 4","86382FL001",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0010013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","4","86382","FL","Individual","No","20-8937577","86382FL0020002","Ambetter Gold 2 + Vision","86382FL002",,"FLN001","FLS001","FLF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020002-01","Standard Gold On Exchange Plan",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020004","Ambetter Gold 4 + Vision","86382FL002",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020010","Ambetter Bronze 1 + Vision","86382FL002",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020010","Ambetter Bronze 1 + Vision","86382FL002",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","5","86382","FL","Individual","No","20-8937577","86382FL0020010","Ambetter Bronze 1 + Vision","86382FL002",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","6","86382","FL","Individual","No","20-8937577","86382FL0020008","Ambetter Silver 4 + Vision","86382FL002",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983118721111812",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0020008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-05","87% AV Level Silver Plan",,"0.878752827644348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030007","Ambetter Silver 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-05","87% AV Level Silver Plan","87.97%","0.879661560058594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","7","86382","FL","Individual","No","20-8937577","86382FL0030009","Ambetter Silver 5 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030004","Ambetter Gold 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030004","Ambetter Gold 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030004","Ambetter Gold 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030010","Ambetter Bronze 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030010","Ambetter Bronze 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030010","Ambetter Bronze 1 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030012","Ambetter Bronze 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030012","Ambetter Bronze 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030012","Ambetter Bronze 3 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030013","Ambetter Bronze 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030013","Ambetter Bronze 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","8","86382","FL","Individual","No","20-8937577","86382FL0030013","Ambetter Bronze 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652448",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","FL","86382","HIOS","4","2013-08-30 07:44:10","9","86382","FL","Individual","No","20-8937577","86382FL0030008","Ambetter Silver 4 + Vision + Adult Dental","86382FL003",,"FLN001","FLS001","FLF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.951382368652449",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.sunshinehealth.com/benefits","http://ambetter.sunshinehealth.com/payments","http://ambetter.sunshinehealth.com/ourplans","http://ambetter.sunshinehealth.com/formulary","86382FL0030008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020001",,"97725FL0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","Individual","Yes","94-2761537","97725FL0010001","Delta Dental PPO Plan 70 for Children","97725FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010001",,"97725FL0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020001",,"97725FL0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","Individual","Yes","94-2761537","97725FL0010001","Delta Dental PPO Plan 70 for Children","97725FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010001",,"97725FL0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020002",,"97725FL0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","Individual","Yes","94-2761537","97725FL0010002","Delta Dental PPO Plan 85 for Children","97725FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010002",,"97725FL0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","Individual","Yes","94-2761537","97725FL0010002","Delta Dental PPO Plan 85 for Children","97725FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010002",,"97725FL0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","1","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020002",,"97725FL0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","Individual","Yes","94-2761537","97725FL0030001","DeltaCare USA Plan 70 for Children","97725FL003",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030001",,"97725FL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040001","DeltaCare USA Plan 70 for Children for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040001",,"97725FL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","Individual","Yes","94-2761537","97725FL0030001","DeltaCare USA Plan 70 for Children","97725FL003",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030001",,"97725FL0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040001","DeltaCare USA Plan 70 for Children for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040001",,"97725FL0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040002","DeltaCare USA Plan 85 for Children for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040002",,"97725FL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","Individual","Yes","94-2761537","97725FL0030002","DeltaCare USA Plan 85 for Children","97725FL003",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030002",,"97725FL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040002","DeltaCare USA Plan 85 for Children for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040002",,"97725FL0040002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","2","97725","FL","Individual","Yes","94-2761537","97725FL0030002","DeltaCare USA Plan 85 for Children","97725FL003",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030002",,"97725FL0030002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","3","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020006",,"97725FL0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","3","97725","FL","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","97725FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010006",,"97725FL0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","3","97725","FL","Individual","Yes","94-2761537","97725FL0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","97725FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010006",,"97725FL0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","3","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020006",,"97725FL0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","4","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020004",,"97725FL0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","4","97725","FL","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","97725FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010004",,"97725FL0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","4","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","97725FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/fl/97725fl0020004",,"97725FL0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","4","97725","FL","Individual","Yes","94-2761537","97725FL0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","97725FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0010004",,"97725FL0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","5","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040004",,"97725FL0040004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","5","97725","FL","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Plan 70 for Children + Basic for Adults","97725FL003",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030006",,"97725FL0030006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","5","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040004",,"97725FL0040004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","5","97725","FL","Individual","Yes","94-2761537","97725FL0030006","DeltaCare USA Plan 70 for Children + Basic for Adults","97725FL003",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030006",,"97725FL0030006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","6","97725","FL","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Plan 85 for Children + Preferred for Adults","97725FL003",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030004",,"97725FL0030004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","6","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040005",,"97725FL0040006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","6","97725","FL","SHOP (Small Group)","Yes","94-2761537","97725FL0040006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","97725FL004",,"FLN002","FLS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/fl/97725fl0040005",,"97725FL0040006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","97725","HIOS","6","2014-01-21 08:29:49","6","97725","FL","Individual","Yes","94-2761537","97725FL0030004","DeltaCare USA Plan 85 for Children + Preferred for Adults","97725FL003",,"FLN002","FLS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/fl/97725fl0030004",,"97725FL0030004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","98534","HIOS","6","2013-10-15 07:27:56","1","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN003","FLS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034",,"98534FL0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-05","87% AV Level Silver Plan",,"0.878752827644348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020002","Ambetter Gold 2 + Vision","45495GA002",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020002","Ambetter Gold 2 + Vision","45495GA002",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020002-03","Limited Cost Sharing Plan Variation",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-05","87% AV Level Silver Plan",,"0.879959166049957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020005","Ambetter Silver 1 + Vision","45495GA002",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020005-06","94% AV Level Silver Plan",,"0.948886394500732","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-05","87% AV Level Silver Plan",,"0.878752827644348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020007","Ambetter Silver 3 + Vision","45495GA002",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020001",,"99787FL0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020002",,"99787FL0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","Individual","Yes","75-1233841","99787FL0010002","Dentegra Dental PPO Children's Plan 85","99787FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010002",,"99787FL0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","Individual","Yes","75-1233841","99787FL0010002","Dentegra Dental PPO Children's Plan 85","99787FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010002",,"99787FL0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020002",,"99787FL0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","2","99787","FL","Individual","Yes","75-1233841","99787FL0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","99787FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010006",,"99787FL0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","2","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020006",,"99787FL0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","2","99787","FL","Individual","Yes","75-1233841","99787FL0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","99787FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010006",,"99787FL0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","2","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020006",,"99787FL0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","98534","HIOS","6","2013-10-15 07:27:56","1","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0240001","Family Basic Dental Plan (Low)","98534FL024",,"FLN003","FLS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034",,"98534FL0240001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","98534","HIOS","6","2013-10-15 07:27:56","2","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN004","FLS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034",,"98534FL0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","98534","HIOS","6","2013-10-15 07:27:56","2","98534","FL","SHOP (Small Group)","Yes","13-5581829","98534FL0250001","Family Enhanced Dental Plan (High)","98534FL025",,"FLN004","FLS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48035",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48034",,"98534FL0250001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020002","Ambetter Gold 2 + Vision","45495GA002",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020002-01","Standard Gold On Exchange Plan",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-05","87% AV Level Silver Plan","87.97%","0.879661560058594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020004","Ambetter Gold 4 + Vision","45495GA002",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020004","Ambetter Gold 4 + Vision","45495GA002",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020004","Ambetter Gold 4 + Vision","45495GA002",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020010","Ambetter Bronze 1 + Vision","45495GA002",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020010","Ambetter Bronze 1 + Vision","45495GA002",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020010","Ambetter Bronze 1 + Vision","45495GA002",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020012","Ambetter Bronze 3 + Vision","45495GA002",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020012","Ambetter Bronze 3 + Vision","45495GA002",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020012","Ambetter Bronze 3 + Vision","45495GA002",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020002",,"28167GA0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","Individual","Yes","75-1233841","28167GA0010002","Dentegra Dental PPO Children's Plan 85","28167GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010002",,"28167GA0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020002",,"28167GA0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","2","28167","GA","Individual","Yes","75-1233841","28167GA0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","28167GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010006",,"28167GA0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","2","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020006",,"28167GA0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","2","28167","GA","Individual","Yes","75-1233841","28167GA0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","28167GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010006",,"28167GA0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","2","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020006",,"28167GA0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","3","28167","GA","Individual","Yes","75-1233841","28167GA0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","28167GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010004",,"28167GA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","3","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020004",,"28167GA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","3","28167","GA","Individual","Yes","75-1233841","28167GA0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","28167GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010004",,"28167GA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","3","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020004",,"28167GA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","Individual","Yes","75-1233841","99787FL0010001","Dentegra Dental PPO Children's Plan 70","99787FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010001",,"99787FL0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020001",,"99787FL0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","1","99787","FL","Individual","Yes","75-1233841","99787FL0010001","Dentegra Dental PPO Children's Plan 70","99787FL001",,"FLN001","FLS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010001",,"99787FL0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","3","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020004",,"99787FL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","3","99787","FL","Individual","Yes","75-1233841","99787FL0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","99787FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010004",,"99787FL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","3","99787","FL","SHOP (Small Group)","Yes","75-1233841","99787FL0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","99787FL002",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/fl/99787fl0020004",,"99787FL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","FL","99787","HIOS","6","2014-01-17 09:36:20","3","99787","FL","Individual","Yes","75-1233841","99787FL0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","99787FL001",,"FLN001","FLS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/fl/99787fl0010004",,"99787FL0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020001",,"28167GA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","Individual","Yes","75-1233841","28167GA0010001","Dentegra Dental PPO Children's Plan 70","28167GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010001",,"28167GA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","SHOP (Small Group)","Yes","75-1233841","28167GA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","28167GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/ga/28167ga0020001",,"28167GA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","Individual","Yes","75-1233841","28167GA0010001","Dentegra Dental PPO Children's Plan 70","28167GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010001",,"28167GA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","28167","HIOS","6","2014-01-17 09:36:20","1","28167","GA","Individual","Yes","75-1233841","28167GA0010002","Dentegra Dental PPO Children's Plan 85","28167GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ga/28167ga0010002",,"28167GA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030004","Ambetter Gold 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030004","Ambetter Gold 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030004","Ambetter Gold 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030010","Ambetter Bronze 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030010","Ambetter Bronze 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030010","Ambetter Bronze 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030012","Ambetter Bronze 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030012","Ambetter Bronze 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030012","Ambetter Bronze 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030013","Ambetter Bronze 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030013","Ambetter Bronze 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","GA","37001","HIOS","9","2014-03-19 07:06:49","1","37001","GA","Individual","Yes","39-1263473","37001GA0540001","Humana Dental Smart Choice","37001GA054",,"GAN002","GAS002",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084342",,"37001GA0540001-01","Standard Low On Exchange Plan","71.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"$150","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010002","Ambetter Gold 2","45495GA001",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010002-01","Standard Gold On Exchange Plan",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010002","Ambetter Gold 2","45495GA001",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010002","Ambetter Gold 2","45495GA001",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010002-03","Limited Cost Sharing Plan Variation",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-05","87% AV Level Silver Plan",,"0.879959166049957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010005","Ambetter Silver 1","45495GA001",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010005-06","94% AV Level Silver Plan",,"0.948886394500732","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010007","Ambetter Silver 3","45495GA001",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-05","87% AV Level Silver Plan","87.97%","0.879661560058594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","1","45495","GA","Individual","No","20-3174593","45495GA0010009","Ambetter Silver 5","45495GA001",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010004","Ambetter Gold 4","45495GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010004-01","Standard Gold On Exchange Plan",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010004","Ambetter Gold 4","45495GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010004","Ambetter Gold 4","45495GA001",,"GAN001","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010004-03","Limited Cost Sharing Plan Variation",,"0.782686471939087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010010","Ambetter Bronze 1","45495GA001",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010010-01","Standard Bronze On Exchange Plan",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010010","Ambetter Bronze 1","45495GA001",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010010","Ambetter Bronze 1","45495GA001",,"GAN001","GAS001","GAF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010010-03","Limited Cost Sharing Plan Variation",,"0.603424966335297","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010012","Ambetter Bronze 3","45495GA001",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010012-01","Standard Bronze On Exchange Plan",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010012","Ambetter Bronze 3","45495GA001",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010012","Ambetter Bronze 3","45495GA001",,"GAN001","GAS001","GAF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010012-03","Limited Cost Sharing Plan Variation",,"0.615748822689056","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010013","Ambetter Bronze 4","45495GA001",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010013","Ambetter Bronze 4","45495GA001",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","2","45495","GA","Individual","No","20-3174593","45495GA0010013","Ambetter Bronze 4","45495GA001",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","3","45495","GA","Individual","No","20-3174593","45495GA0010008","Ambetter Silver 4","45495GA001",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0010008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","4","45495","GA","Individual","No","20-3174593","45495GA0020009","Ambetter Silver 5 + Vision","45495GA002",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020013","Ambetter Bronze 4 + Vision","45495GA002",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020013-01","Standard Bronze On Exchange Plan",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020013","Ambetter Bronze 4 + Vision","45495GA002",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","5","45495","GA","Individual","No","20-3174593","45495GA0020013","Ambetter Bronze 4 + Vision","45495GA002",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No",,,,"http://ambetter.pshpgeorgia.com/formulary","45495GA0020013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","6","45495","GA","Individual","No","20-3174593","45495GA0020008","Ambetter Silver 4 + Vision","45495GA002",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9816",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0020008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030002","Ambetter Gold 2 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030002-01","Standard Gold On Exchange Plan",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030002","Ambetter Gold 2 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030002","Ambetter Gold 2 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030002-03","Limited Cost Sharing Plan Variation",,"0.781822681427002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-05","87% AV Level Silver Plan",,"0.879959166049957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030005","Ambetter Silver 1 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030005-06","94% AV Level Silver Plan",,"0.948886394500732","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-05","87% AV Level Silver Plan",,"0.878752827644348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030007","Ambetter Silver 3 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","7","45495","GA","Individual","No","20-3174593","45495GA0030009","Ambetter Silver 5 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030009-05","87% AV Level Silver Plan","87.97%","0.879661560058594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","8","45495","GA","Individual","No","20-3174593","45495GA0030013","Ambetter Bronze 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030013-03","Limited Cost Sharing Plan Variation",,"0.616434276103973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","GA","45495","HIOS","4","2013-08-30 07:44:10","9","45495","GA","Individual","No","20-3174593","45495GA0030008","Ambetter Silver 4 + Vision + Adult Dental","45495GA003",,"GAN001","GAS001","GAF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9484",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.pshpgeorgia.com/benefits","http://ambetter.pshpgeorgia.com/payments","http://ambetter.pshpgeorgia.com/ourplans","http://ambetter.pshpgeorgia.com/formulary","45495GA0030008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420001","BCBSHP Gold Direct Access Plus-groa","49046GA042",,"GAN001","GAS001","GAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986038852206727",,,"0","0","3","2014-01-01",,"No","Follows OON Coverage for Urgent/Emergent Care ONLY","Yes","Follows OON Coverage only within the State boundaries; external to the State there is NO OON benefits except Urgent/Emergent","No","https://sbc.bcbsga.com/dps/","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03399GAMENBGA.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0420001-01","Standard Gold On Exchange Plan","79.92%","0.796827614307404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","Individual","No","58-1638390","49046GA0410006","BCBSHP Bronze DirectAccess w/Child Dental - cdae","49046GA041",,"GAN002","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5H","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410006-01","Standard Bronze On Exchange Plan","61.98%","0.632126569747925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420002","BCBSHP Silver Direct Access Plus-gwoa","49046GA042",,"GAN001","GAS001","GAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.982098515771042",,,"0","0","3","2014-01-01",,"No","Follows OON Coverage for Urgent/Emergent Care ONLY","Yes","Follows OON Coverage only within the State boundaries; external to the State there is NO OON benefits except Urgent/Emergent","No","https://sbc.bcbsga.com/dps/","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03399GAMENBGA.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0420002-01","Standard Silver On Exchange Plan","70.49%","0.704030215740204","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,500","$3,000","35%",,,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","30%",,,,"$500","$1,000","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","Individual","No","58-1638390","49046GA0410006","BCBSHP Bronze DirectAccess w/Child Dental - cdae","49046GA041",,"GAN002","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5H","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","SHOP (Small Group)","No","58-1638390","49046GA0420003","BCBSHP Bronze Direct Access Plus-gkqa","49046GA042",,"GAN001","GAS001","GAF003","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.978273396563637",,,"0","0","3","2014-01-01",,"No","Follows OON Coverage for Urgent/Emergent Care ONLY","Yes","Follows OON Coverage only within the State boundaries; external to the State there is NO OON benefits except Urgent/Emergent","No","https://sbc.bcbsga.com/dps/","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03399GAMENBGA.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0420003-01","Standard Bronze On Exchange Plan","58.16%","0","No","No","No","100%",,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$6,350","$12,700",,,"$6,350","$12,700","$6,350","$12,700",,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","8","49046","GA","Individual","No","58-1638390","49046GA0410013","BCBSHP Catastrophic DirectAccess","49046GA041",,"GAN001","GAS001","GAF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6C","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","50491","HIOS","1","2013-06-06 10:50:48","1","50491","GA","Individual","Yes","59-1031071","50491GA0030001","myCigna Dental Pediatric","50491GA003","7730182962","GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$34.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"50491GA0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50662","HIOS","1","2013-06-06 10:50:48","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010001","DentalConnect�","50662GA001",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"50662GA0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50662","HIOS","1","2013-06-06 10:50:48","1","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010002","DentalConnect�","50662GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"50662GA0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50662","HIOS","1","2013-06-06 10:50:48","2","50662","GA","SHOP (Small Group)","Yes","35-0472300","50662GA0010003","DentalConnect�","50662GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"50662GA0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","1","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0150001","Smile for Health Child C80A80","50988GA015",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$25.24",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c80a80-ppo.pdf",,,,"50988GA0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","3","86637","GA","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","86637GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010004",,"86637GA0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","3","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020004",,"86637GA0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","3","86637","GA","Individual","Yes","94-2761537","86637GA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","86637GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010004",,"86637GA0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","3","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020004",,"86637GA0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-06","94% AV Level Silver Plan","93.90%","0.92780464887619","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$200","$200","$0","$400","$10","$80","15"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-04","73% AV Level Silver Plan","73.30%","0.71604984998703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,300","$20","$600","$200","$1,000","$700","$0","$80","7"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050007","SimpleCare","83761GA005",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050007-01","Standard Silver On Exchange Plan","70.40%","65.12%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$32,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","45%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"17"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-06","94% AV Level Silver Plan","93.20%","93.71%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$1,200","$2,400","$1,600","$3,200",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$600","$1,200","$800","$1,600",,,,,,,,,"17"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050010","SimpleCare","83761GA005",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050010-00","Standard Silver Off Exchange Plan","71.80%","66.50%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"22"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","6","89942","GA","Individual","No","58-1592076","89942GA0050008","KP GA Bronze 4500/50/HSA","89942GA005",,"GAN001","GAS002","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","6","89942","GA","Individual","No","58-1592076","89942GA0050008","KP GA Bronze 4500/50/HSA","89942GA005",,"GAN001","GAS002","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050008-03","Limited Cost Sharing Plan Variation","59.60%","0.590750634670258","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$20","$0","$200","$100","$1,600","$0","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-06","94% AV Level Silver Plan","93.20%","0.923348605632782","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$200","$200","$100","$400","$40","$80","9"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050007-01","Standard Bronze On Exchange Plan","62.00%","0.609316885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,300","$20","$0","$200","$100","$1,900","$0","$80","4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710002","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","1","49046","GA","Individual","No","58-1638390","49046GA0410006","BCBSHP Bronze DirectAccess w/Child Dental - cdae","49046GA041",,"GAN002","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5H","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410006-03","Limited Cost Sharing Plan Variation","61.98%","0.632126569747925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","2","49046","GA","Individual","No","58-1638390","49046GA0410012","BCBSHP Gold DirectAccess w/Child Dental - cdcp","49046GA041",,"GAN002","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410012-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","2","49046","GA","Individual","No","58-1638390","49046GA0410012","BCBSHP Gold DirectAccess w/Child Dental - cdcp","49046GA041",,"GAN002","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","2","49046","GA","Individual","No","58-1638390","49046GA0410012","BCBSHP Gold DirectAccess w/Child Dental - cdcp","49046GA041",,"GAN002","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410012-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410005","BCBSHP Bronze DirectAccess - caaw","49046GA041",,"GAN001","GAS001","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410005-01","Standard Bronze On Exchange Plan","61.84%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410005","BCBSHP Bronze DirectAccess - caaw","49046GA041",,"GAN001","GAS001","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410005","BCBSHP Bronze DirectAccess - caaw","49046GA041",,"GAN001","GAS001","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5B","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410005-03","Limited Cost Sharing Plan Variation","61.84%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410003","BCBSHP Bronze DirectAccess - caae","49046GA041",,"GAN001","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S59","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410003-01","Standard Bronze On Exchange Plan","61.98%","0.632126569747925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410003","BCBSHP Bronze DirectAccess - caae","49046GA041",,"GAN001","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S59","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","3","49046","GA","Individual","No","58-1638390","49046GA0410003","BCBSHP Bronze DirectAccess - caae","49046GA041",,"GAN001","GAS001","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S59","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410003-03","Limited Cost Sharing Plan Variation","61.98%","0.632126569747925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","4","49046","GA","Individual","No","58-1638390","49046GA0410002","BCBSHP Bronze DirectAccess - cabr","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0XB1","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410002-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","4","49046","GA","Individual","No","58-1638390","49046GA0410002","BCBSHP Bronze DirectAccess - cabr","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0XB1","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","4","49046","GA","Individual","No","58-1638390","49046GA0410002","BCBSHP Bronze DirectAccess - cabr","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0XB1","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410002-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410001","BCBSHP Bronze DirectAccess w/HSA - caar","49046GA041",,"GAN001","GAS001","GAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S57","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410001-01","Standard Bronze On Exchange Plan","58.20%","0.58094722032547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410001","BCBSHP Bronze DirectAccess w/HSA - caar","49046GA041",,"GAN001","GAS001","GAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S57","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410001","BCBSHP Bronze DirectAccess w/HSA - caar","49046GA041",,"GAN001","GAS001","GAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S57","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410001-03","Limited Cost Sharing Plan Variation","58.20%","0.58094722032547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-01","Standard Silver On Exchange Plan","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-03","Limited Cost Sharing Plan Variation","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-04","73% AV Level Silver Plan","72.80%","0.731756865978241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-05","87% AV Level Silver Plan","86.13%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410007","BCBSHP Silver DirectAccess w/HSA - cbbg","49046GA041",,"GAN001","GAS001","GAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5K","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410007-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410004","BCBSHP Bronze DirectAccess w/HSA - cabp","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5A","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410004-01","Standard Bronze On Exchange Plan","58.09%","0.615073502063751","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410004","BCBSHP Bronze DirectAccess w/HSA - cabp","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5A","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","5","49046","GA","Individual","No","58-1638390","49046GA0410004","BCBSHP Bronze DirectAccess w/HSA - cabp","49046GA041",,"GAN001","GAS001","GAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5A","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410004-03","Limited Cost Sharing Plan Variation","58.09%","0.615073502063751","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410011","BCBSHP Gold DirectAccess - ccab","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S69","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410011-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410011","BCBSHP Gold DirectAccess - ccab","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S69","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410011","BCBSHP Gold DirectAccess - ccab","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S69","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410011-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-01","Standard Silver On Exchange Plan","70.30%","0.702527940273285","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-03","Limited Cost Sharing Plan Variation","70.30%","0.702527940273285","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-04","73% AV Level Silver Plan","72.30%","0.720496594905853","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-05","87% AV Level Silver Plan","86.10%","0.859066247940063","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","6","49046","GA","Individual","No","58-1638390","49046GA0410008","BCBSHP Silver DirectAccess - cbaa","49046GA041",,"GAN001","GAS001","GAF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","Yes","http://www.sbc.anthem.com/dps/CCD0S5Q","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410008-06","94% AV Level Silver Plan","93.30%","0.926097571849823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-01","Standard Silver On Exchange Plan","71.00%","0.715095460414886","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-03","Limited Cost Sharing Plan Variation","71.00%","0.715095460414886","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-04","73% AV Level Silver Plan","73.12%","0.734771132469177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-05","87% AV Level Silver Plan","86.10%","0.862314343452454","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410009","BCBSHP Silver DirectAccess - cbiq","49046GA041",,"GAN001","GAS001","GAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S5V","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410009-06","94% AV Level Silver Plan","93.07%","0.931488215923309","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-01","Standard Silver On Exchange Plan","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-03","Limited Cost Sharing Plan Variation","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-04","73% AV Level Silver Plan","72.75%","0.732995271682739","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-05","87% AV Level Silver Plan","86.32%","0.865209221839905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","GA","49046","HIOS","8","2014-01-16 07:24:04","7","49046","GA","Individual","No","58-1638390","49046GA0410010","BCBSHP Silver DirectAccess - cbds","49046GA041",,"GAN001","GAS001","GAF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S60","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0410010-06","94% AV Level Silver Plan","93.23%","0.933509588241577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050002","SimpleCare","83761GA005",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050002-00","Standard Gold Off Exchange Plan","80.10%","79.99%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"6"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010006","BEST Dental Basic - Silver","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Basic_Plan_(Silver).pdf",,"83502GA0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010006","BEST Dental Basic - Silver","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Basic_Plan_(Silver).pdf",,"83502GA0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020006","BEST Dental Basic - Silver","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"83502GA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050002","SimpleCare","83761GA005",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050002-01","Standard Gold On Exchange Plan","80.10%","79.99%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","4","50988","GA","Individual","Yes","86-0307623","50988GA0040001","Smile for Health Child C60A50","50988GA004",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020002",,"86637GA0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","Individual","Yes","94-2761537","86637GA0010002","Delta Dental PPO Plan 85 for Children","86637GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010002",,"86637GA0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","2","86637","GA","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","86637GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010006",,"86637GA0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","2","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020006",,"86637GA0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","2","86637","GA","Individual","Yes","94-2761537","86637GA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","86637GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010006",,"86637GA0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","2","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020006",,"86637GA0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-04","73% AV Level Silver Plan","73.80%","73.95%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$13,800","$27,600","$18,400","$36,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"15"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050007","SimpleCare","83761GA005",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050007-00","Standard Silver Off Exchange Plan","70.40%","65.12%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$32,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","45%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"16"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-05","87% AV Level Silver Plan","86.60%","87.36%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"16"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","Individual","Yes","86-0307623","50988GA0070001","Smile for Health Child C80A80","50988GA007",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0090001","Smile for Health Child C60A70","50988GA009",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$20.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a70-ppo.pdf",,,,"50988GA0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 0/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"4","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050002-03","Limited Cost Sharing Plan Variation","81.10%","0.797483503818512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,000","$200","$200","$0","$900","$40","$80","6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710007","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710007-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710020-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710021","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710021-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","5","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0100002","Smile for Health Family C60A60","50988GA010",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$24.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a60-ppo.pdf",,,,"50988GA0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0090001","Smile for Health Child C60A70","50988GA009",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$20.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a70-ppo.pdf",,,,"50988GA0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","Individual","Yes","86-0307623","50988GA0070001","Smile for Health Child C80A80","50988GA007",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","6","89942","GA","Individual","No","58-1592076","89942GA0050008","KP GA Bronze 4500/50/HSA","89942GA005",,"GAN001","GAS002","GAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050008-01","Standard Bronze On Exchange Plan","59.60%","0.590750634670258","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$20","$0","$200","$100","$1,600","$0","$80","4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","No","35-0781558","17575IN0700007","Anthem Bronze DirectAccess w/Child Dental - cdaa","17575IN070",,"INN002","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.sbc.anthem.com/dps/CCD0S6F","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700007-03","Limited Cost Sharing Plan Variation","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0810002","Anthem Dental Pediatric Enhanced","17575IN081",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e213346.pdf",,,,"17575IN0810002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","Yes","35-0781558","17575IN0840002","Anthem Dental Pediatric Enhanced","17575IN084",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e213346.pdf",,,,"17575IN0840002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830001","Anthem Dental Family","17575IN083",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212883.pdf",,,,"17575IN0830001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","Yes","35-0781558","17575IN0860001","Anthem Dental Family","17575IN086",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212883.pdf",,,,"17575IN0860001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","4","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0200001","Smile for Health Child C80","50988GA020",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$49.23",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","4","50988","GA","Individual","Yes","86-0307623","50988GA0040002","Smile For Health Family C60A50","50988GA004",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010002","BEST Life Child Dental","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Child_Dental_Plan.pdf",,"83502GA0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020002","BEST Life Child Dental","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Child_Dental_Plan.pdf",,"83502GA0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010003","BEST Dental Advantage - Gold","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"83502GA0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020003","BEST Dental Advantage - Gold","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"83502GA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020003","BEST Dental Advantage - Gold","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"83502GA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010003","BEST Dental Advantage - Gold","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"83502GA0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020004","BEST Dental Plus - Gold","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"83502GA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010004","BEST Dental Plus - Gold","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Plus_Plan_(Gold).pdf",,"83502GA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020004","BEST Dental Plus - Gold","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"83502GA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010004","BEST Dental Plus - Gold","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Plus_Plan_(Gold).pdf",,"83502GA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020005","BEST Dental Plus - Silver","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Denta_Plus_Plan_(Silver).pdf",,"83502GA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010005","BEST Dental Plus - Silver","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Plus_Plan_(Silver).pdf",,"83502GA0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","4","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0190001","Guardian Family Essentials","63940GA019",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0190001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","4","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0190001","Guardian Family Essentials","63940GA019",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0190001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0020001","Delta Dental Individual PPO, EHB Certified","73231GA002",,"GAN002","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0040001","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.86",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0040002","Renaissance Group Dental PPO, EHB Certified","73231GA004",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.32",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0020002","Delta Dental Individual PPO, EHB Certified","73231GA002",,"GAN002","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0030001","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090001","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_EHB_Group_High",,"www.renaissancedental.com/GA_EHB_Group_High",,"73231GA0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0030002","Renaissance Individual Dental PPO, EHB Certified","73231GA003",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090002","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_EHB_Group_Low",,"www.renaissancedental.com/GA_EHB_Group_Low",,"73231GA0090002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0070001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_EHB_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","www.renaissancedental.com/GA_EHB_Plan_Brochure",,"73231GA0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090003","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_50_50_High",,"www.renaissancedental.com/GA_50_50_High",,"73231GA0090003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","SHOP (Small Group)","Yes","47-0397286","73231GA0090004","Renaissance Group Dental PPO, EHB Certified (Exchange)","73231GA009",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_50_50_Low",,"www.renaissancedental.com/GA_50_50_Low",,"73231GA0090004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","1","73231","GA","Individual","Yes","47-0397286","73231GA0070002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","73231GA007",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_EHB_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","www.renaissancedental.com/GA_EHB_Plan_Brochure",,"73231GA0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","2","73231","GA","Individual","Yes","47-0397286","73231GA0060001","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$31.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","2","73231","GA","Individual","Yes","47-0397286","73231GA0060002","Renaissance Individual Dental Pediatric-Only, EHB Certified","73231GA006",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"73231GA0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","2","73231","GA","Individual","Yes","47-0397286","73231GA0080001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_Ped_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","www.renaissancedental.com/GA_EHB_Plan_Brochure",,"73231GA0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","73231","HIOS","6","2013-11-26 13:14:08","2","73231","GA","Individual","Yes","47-0397286","73231GA0080002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","73231GA008",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$29.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/GA_Ped_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/73231","www.renaissancedental.com/GA_EHB_Plan_Brochure",,"73231GA0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","1","50988","GA","Individual","Yes","86-0307623","50988GA0170001","Smile for Health Child C60","50988GA017",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","1","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0150001","Smile for Health Child C80A80","50988GA015",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$25.24",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c80a80-ppo.pdf",,,,"50988GA0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","1","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0150002","Smile for Health Family C80A80","50988GA015",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$25.24",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c80a80-ppo.pdf",,,,"50988GA0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","1","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0150002","Smile for Health Family C80A80","50988GA015",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$25.24",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c80a80-ppo.pdf",,,,"50988GA0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","Individual","Yes","86-0307623","50988GA0010002","Smile for Health Family C60A70","50988GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0120001","Smile for Health Child C60A50","50988GA012",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$18.49",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a50-ppo.pdf",,,,"50988GA0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0120001","Smile for Health Child C60A50","50988GA012",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$18.49",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a50-ppo.pdf",,,,"50988GA0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","Individual","Yes","86-0307623","50988GA0010002","Smile for Health Family C60A70","50988GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0120002","Smile for Health Family C60A50","50988GA012",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$18.49",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a50-ppo.pdf",,,,"50988GA0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","Individual","Yes","86-0307623","50988GA0010001","Smile for Health Child C60A70","50988GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0120002","Smile for Health Family C60A50","50988GA012",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$18.49",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a50-ppo.pdf",,,,"50988GA0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","2","50988","GA","Individual","Yes","86-0307623","50988GA0010001","Smile for Health Child C60A70","50988GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","3","50988","GA","Individual","Yes","86-0307623","50988GA0020001","Smile for Health Child C60A60","50988GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","3","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0190001","Smile for Health Child C60","50988GA019",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$24.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","3","50988","GA","Individual","Yes","86-0307623","50988GA0020001","Smile for Health Child C60A60","50988GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","3","50988","GA","Individual","Yes","86-0307623","50988GA0020002","Smile for Health Family C60A60","50988GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","3","50988","GA","Individual","Yes","86-0307623","50988GA0020002","Smile for Health Family C60A60","50988GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","5","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0100001","Smile for Health Child C60A60","50988GA010",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$24.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a60-ppo.pdf",,,,"50988GA0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","5","50988","GA","Individual","Yes","86-0307623","50988GA0180001","Smile for Health Child C80","50988GA018",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","5","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0100001","Smile for Health Child C60A60","50988GA010",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$24.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-child-c60a60-ppo.pdf",,,,"50988GA0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","5","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0100002","Smile for Health Family C60A60","50988GA010",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$24.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a60-ppo.pdf",,,,"50988GA0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","Individual","Yes","86-0307623","50988GA0070002","Smile for Health Family C80A80","50988GA007",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0090002","Smile for Health Family C60A70","50988GA009",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$20.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a70-ppo.pdf",,,,"50988GA0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","Individual","Yes","86-0307623","50988GA0070002","Smile for Health Family C80A80","50988GA007",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-ga-idental",,,"50988GA0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","6","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0090002","Smile for Health Family C60A70","50988GA009",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$20.08",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-ga-grp-family-c60a70-ppo.pdf",,,,"50988GA0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","7","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0110001","Smile for Health Child C60A80","50988GA011",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$13.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","7","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0110002","Smile for Health Family C60A80","50988GA011",,"GAN001","GAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$13.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","8","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0130001","Smile for Health Child C80A70","50988GA013",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$24.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","8","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0130002","Smile for Health Family C80A70","50988GA013",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$24.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","9","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0140001","Smile for Health Child C80A60","50988GA014",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$25.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","9","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0140002","Smile for Health Child C80A60","50988GA014",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$25.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","10","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0160001","Smile for Health Child C80A50","50988GA016",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Child-Only",,,,"$24.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","50988","HIOS","5","2013-09-12 11:27:35","10","50988","GA","SHOP (Small Group)","Yes","86-0307623","50988GA0160002","Smile for Health Family C80A50","50988GA016",,"GAN001","GAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures),2) The responsibility of Workers’ Compensation or employer’s liability insurance. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess. 3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19.  For additional detail on full exclusions, please refer to your plan documents",,,,,"Allows Adult and Child-Only",,,,"$24.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"50988GA0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","1","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0160001","EHB Basic Dental Plan (Low)","55612GA016",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$16.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48037",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48036",,"55612GA0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","1","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0160001","EHB Basic Dental Plan (Low)","55612GA016",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$16.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48037",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48036",,"55612GA0160001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","2","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0170001","EHB Enhanced Dental Plan (High)","55612GA017",,"GAN002","GAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49076",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49075",,"55612GA0170001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","2","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0170001","EHB Enhanced Dental Plan (High)","55612GA017",,"GAN002","GAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49076",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49075",,"55612GA0170001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","3","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN003","GAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$16.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077",,"55612GA0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","3","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0180001","Family Basic Dental Plan (Low)","55612GA018",,"GAN003","GAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$16.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49078",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49077",,"55612GA0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","4","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN004","GAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079",,"55612GA0190001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","55612","HIOS","5","2013-10-16 16:52:58","4","55612","GA","SHOP (Small Group)","Yes","13-5581929","55612GA0190001","Family Enhanced Dental Plan (High)","55612GA019",,"GAN004","GAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49080",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49079",,"55612GA0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","1","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0460001","Anthem Dental Pediatric","63411GA046",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209943.pdf",,,,"63411GA0460001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","1","63411","GA","Individual","Yes","58-0469845","63411GA0490001","Anthem Dental Pediatric","63411GA049",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209943.pdf",,,,"63411GA0490001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","1","63411","GA","Individual","Yes","58-0469845","63411GA0490050","Anthem Dental Pediatric Enhanced","63411GA049",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e213352.pdf",,,,"63411GA0490050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","1","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0460002","Anthem Dental Pediatric Enhanced","63411GA046",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e213352.pdf",,,,"63411GA0460002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","2","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0480001","Anthem Dental Family","63411GA048",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209941.pdf",,,,"63411GA0480001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","2","63411","GA","Individual","Yes","58-0469845","63411GA0510001","Anthem Dental Family","63411GA051",,"GAN001","GAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209941.pdf",,,,"63411GA0510001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","2","63411","GA","SHOP (Small Group)","Yes","58-0469845","63411GA0480002","Anthem Dental Family Enhanced","63411GA048",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209942.pdf",,,,"63411GA0480002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63411","HIOS","7","2014-05-02 13:10:05","2","63411","GA","Individual","Yes","58-0469845","63411GA0510050","Anthem Dental Family Enhanced","63411GA051",,"GAN001","GAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.bcbsga.com/agent/noapplication/f0/s0/t0/pw_e209942.pdf",,,,"63411GA0510050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0140001","Guardian Pediatric Advantage","63940GA014",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0140001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0140001","Guardian Pediatric Advantage","63940GA014",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0140001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0150001","Guardian Pediatric Essentials","63940GA015",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0150001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","1","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0150001","Guardian Pediatric Essentials","63940GA015",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0150001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0160001","Guardian Family Advantage Plus","63940GA016",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0160001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","2","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0160001","Guardian Family Advantage Plus","63940GA016",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0160001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","3","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0180001","Guardian Family Essentials Plus","63940GA018",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0180001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","3","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0180001","Guardian Family Essentials Plus","63940GA018",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0180001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","4","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0170001","Guardian Family Advantage","63940GA017",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0170001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","63940","HIOS","4","2013-09-02 11:39:25","4","63940","GA","SHOP (Small Group)","Yes","13-5123390","63940GA0170001","Guardian Family Advantage","63940GA017",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"63940GA0170001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020001","BEST Life Child Dental Plus","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Child_Dental_Plus_Plan.pdf",,"83502GA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010001","BEST Life Child Dental Plus","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Child_Dental_Plus_Plan.pdf",,"83502GA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010001","BEST Life Child Dental Plus","83502GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Child_Dental_Plus_Plan.pdf",,"83502GA0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020001","BEST Life Child Dental Plus","83502GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Child_Dental_Plus_Plan.pdf",,"83502GA0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010002","BEST Life Child Dental","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Child_Dental_Plan.pdf",,"83502GA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020002","BEST Life Child Dental","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Child_Dental_Plan.pdf",,"83502GA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020005","BEST Dental Plus - Silver","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Denta_Plus_Plan_(Silver).pdf",,"83502GA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","SHOP (Small Group)","Yes","95-6042390","83502GA0010005","BEST Dental Plus - Silver","83502GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BEST_Dental_Plus_Plan_(Silver).pdf",,"83502GA0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","GA","83502","HIOS","8","2014-01-21 08:29:49","1","83502","GA","Individual","Yes","95-6042390","83502GA0020006","BEST Dental Basic - Silver","83502GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.02",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/GA/pdf/GA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"83502GA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-00","Standard Silver Off Exchange Plan","71.80%","72.02%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"11"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-01","Standard Silver On Exchange Plan","71.80%","72.02%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"12"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare","83761GA004",,"GAN001","GAS001","GAF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040003-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare","83761GA004",,"GAN001","GAS001","GAF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040003-03","Limited Cost Sharing Plan Variation","78.30%","78.66%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"15"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","Individual","No","58-2335921","83761GA0040010","SoloCare","83761GA004",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040010-03","Limited Cost Sharing Plan Variation","71.80%","72.02%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"14"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","1","83761","GA","SHOP (Small Group)","No","58-2335921","83761GA0050010","SimpleCare","83761GA005",,"GAN001","GAS001","GAF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.alliantplans.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0050010-01","Standard Silver On Exchange Plan","71.80%","66.50%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"23"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare","83761GA004",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040002-00","Standard Gold Off Exchange Plan","79.20%","82.03%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"8"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare","83761GA004",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040002-01","Standard Gold On Exchange Plan","79.20%","82.03%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720003","Anthem Gold Direct Access Plus w/H S A ghab","17575IN072",,"INN002","INS001","INF003","New","HMO","Gold","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99263766945957",,,"0","0","0","2014-01-01",,"Yes","Follow OON Coverage","Yes","Follow OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0720003-01","Standard Gold On Exchange Plan",,"0.783587574958801","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","$1,250","$2,500","$1,250","$0","$600","$150","$1,250","$0","$400","$80","4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","No","35-0781558","17575IN0700013","Anthem Gold DirectAccess w/Child Dental - cdcp","17575IN070",,"INN002","INS001","INF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T24","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700013-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830001","Anthem Dental Family","17575IN083",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212883.pdf",,,,"17575IN0830001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","No","35-0781558","17575IN0700013","Anthem Gold DirectAccess w/Child Dental - cdcp","17575IN070",,"INN002","INS001","INF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T24","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","Yes","35-0781558","17575IN0860001","Anthem Dental Family","17575IN086",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212883.pdf",,,,"17575IN0860001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","Yes","35-0781558","17575IN0860002","Anthem Dental Family Enhanced","17575IN086",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212884.pdf",,,,"17575IN0860002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","No","35-0781558","17575IN0700013","Anthem Gold DirectAccess w/Child Dental - cdcp","17575IN070",,"INN002","INS001","INF006","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T24","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700013-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700003","Anthem Bronze DirectAccess - caae","17575IN070",,"INN001","INS001","INF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8S","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700003-01","Standard Bronze On Exchange Plan","60.28%","0.62304824590683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0730001","Anthem Bronze Direct Access Plus-gjqa","17575IN073",,"INN002","INS001","INF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989692564425194",,,"0","0","3","2014-01-01",,"Yes","Follow OON Coverage","Yes","Follow OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0730001-01","Standard Bronze On Exchange Plan","58.72%","0","No","No","No","100%",,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$6,350","$12,700",,,"$6,350","$12,700","$6,350","$12,700",,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$0","$0","30%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$5,000","$520","$0","$150","$5,000","$50","$40","$80","4"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare","83761GA004",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040002-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040002","SoloCare","83761GA004",,"GAN001","GAS001","GAF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040002-03","Limited Cost Sharing Plan Variation","79.20%","82.03%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"11"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare","83761GA004",,"GAN001","GAS001","GAF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040003-00","Standard Gold Off Exchange Plan","78.30%","78.66%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"12"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","3","83761","GA","Individual","No","58-2335921","83761GA0040003","SoloCare","83761GA004",,"GAN001","GAS001","GAF013","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040003-01","Standard Gold On Exchange Plan","78.30%","78.66%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,"13"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060006","KP GA Bronze 4500/25/40/S1","89942GA006",,"GAN001","GAS001","GAF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060006-01","Standard Bronze On Exchange Plan","61.70%","0.611609995365143","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$20","$0","$200","$100","$1,800","$0","$80","4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-04","73% AV Level Silver Plan","72.74%","0.730981647968292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-05","87% AV Level Silver Plan","86.05%","0.86217075586319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-06","94% AV Level Silver Plan","93.04%","0.930409133434296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700001","Anthem Bronze DirectAccess - caaa","17575IN070",,"INN001","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6E","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700001-01","Standard Bronze On Exchange Plan","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-01","Standard Silver On Exchange Plan","69.00%","0.676773250102997","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$20","$600","$200","$1,000","$900","$0","$80","4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710016-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana National Preferred Gold 2500/3500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104063","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058745","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720006-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720007","Humana National Preferred Platinum 1000/1500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104076","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058771","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720007-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-00","Standard Silver Off Exchange Plan","68.90%","69.91%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"18"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-01","Standard Silver On Exchange Plan","68.90%","69.91%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"19"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-03","Limited Cost Sharing Plan Variation","68.90%","69.91%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"21"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-04","73% AV Level Silver Plan","73.80%","73.69%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$13,200","$26,400","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","20%",,,,"$6,600","$13,200","$8,800","$17,600",,,,,,,,,"22"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-05","87% AV Level Silver Plan","86.50%","86.72%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"23"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","4","83761","GA","Individual","No","58-2335921","83761GA0040015","SoloCare","83761GA004",,"GAN001","GAS001","GAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040015-06","94% AV Level Silver Plan","94.20%","94.42%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$1,200","$2,400","$1,600","$3,200",,,,,,,,,,,,,,,,,,,,,"$75","$150","20%",,,,"$225","$450","$300","$600",,,,,,,,,"24"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","6","83761","GA","Individual","No","58-2335921","83761GA0040020","SoloCare","83761GA004",,"GAN001","GAS001","GAF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040020-00","Standard Bronze Off Exchange Plan","61.30%","61.32%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"4"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","6","83761","GA","Individual","No","58-2335921","83761GA0040020","SoloCare","83761GA004",,"GAN001","GAS001","GAF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040020-01","Standard Bronze On Exchange Plan","61.30%","61.32%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"5"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","6","83761","GA","Individual","No","58-2335921","83761GA0040020","SoloCare","83761GA004",,"GAN001","GAS001","GAF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040020-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","6","83761","GA","Individual","No","58-2335921","83761GA0040020","SoloCare","83761GA004",,"GAN001","GAS001","GAF011","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040020-03","Limited Cost Sharing Plan Variation","61.30%","61.32%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"7"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","7","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare","83761GA004",,"GAN001","GAS001","GAF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040021-00","Standard Bronze Off Exchange Plan","59.10%","59.99%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"4"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","7","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare","83761GA004",,"GAN001","GAS001","GAF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040021-01","Standard Bronze On Exchange Plan","59.10%","59.99%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"5"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","7","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare","83761GA004",,"GAN001","GAS001","GAF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040021-02","Zero Cost Sharing Plan Variation","100.00%","100.00%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","GA","83761","HIOS","10","2014-03-19 07:06:49","7","83761","GA","Individual","No","58-2335921","83761GA0040021","SoloCare","83761GA004",,"GAN001","GAS001","GAF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"0.9988",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is avialable.  See www.AHPAssist.com for details","No","www.AHPAssist.com","www.AHPAssist.com","www.AHPAssist.com","www.alliantplans.com","83761GA0040021-03","Limited Cost Sharing Plan Variation","59.10%","59.99%","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,"7"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020001",,"86637GA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","Individual","Yes","94-2761537","86637GA0010001","Delta Dental PPO Plan 70 for Children","86637GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010001",,"86637GA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020001",,"86637GA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","Individual","Yes","94-2761537","86637GA0010001","Delta Dental PPO Plan 70 for Children","86637GA001",,"GAN001","GAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010001",,"86637GA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","Individual","Yes","94-2761537","86637GA0010002","Delta Dental PPO Plan 85 for Children","86637GA001",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ga/86637ga0010002",,"86637GA0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","86637","HIOS","6","2014-01-21 08:29:49","1","86637","GA","SHOP (Small Group)","Yes","94-2761537","86637GA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","86637GA002",,"GAN001","GAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/ga/86637ga0020002",,"86637GA0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-03","Limited Cost Sharing Plan Variation","69.00%","0.676773250102997","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$20","$600","$200","$1,000","$900","$0","$80","6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720007","Humana National Preferred Platinum 1000/1500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104076","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058771","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720007-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","1","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060002","KP GA Gold 0/0/30/S1","89942GA006",,"GAN001","GAS001","GAF011","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060002-01","Standard Gold On Exchange Plan","81.80%","0.804115116596222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,100","$0","$200","$0","$1,500","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050003-03","Limited Cost Sharing Plan Variation","78.10%","0.762865900993347","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$700","$200","$100","$900","$0","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-01","Standard Silver On Exchange Plan","71.90%","0.701062917709351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$800","$200","$100","$1,200","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050007-03","Limited Cost Sharing Plan Variation","62.00%","0.609316885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,300","$20","$0","$200","$100","$1,900","$0","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 0/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"4","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050002-01","Standard Gold On Exchange Plan","81.10%","0.797483503818512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$2,000","$200","$200","$0","$900","$40","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","1","89942","GA","Individual","No","58-1592076","89942GA0050002","KP GA Gold 0/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"4","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050003-01","Standard Gold On Exchange Plan","78.10%","0.762865900993347","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$700","$200","$100","$900","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","2","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060003","KP GA Gold 1000/20/30/S1","89942GA006",,"GAN001","GAS001","GAF011","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060003-01","Standard Gold On Exchange Plan","78.30%","0.769418478012085","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$700","$200","$100","$1,500","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","2","89942","GA","Individual","No","58-1592076","89942GA0050003","KP GA Gold 1000/20","89942GA005",,"GAN001","GAS002","GAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060004","KP GA Silver 2000/25/40/S1","89942GA006",,"GAN001","GAS001","GAF012","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/ga_summaryofbenefits.html",,"https://businessnet.kp.org/health/plans/ga/plans/smallbusiness?contentid=/html/plans/ga/small/entrypage.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060004-01","Standard Silver On Exchange Plan","71.60%","0.693144142627716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$600","$200","$100","$1,600","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060005","KP GA Silver  2000/40/40/S1","89942GA006",,"GAN001","GAS001","GAF017","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060005-01","Standard Silver On Exchange Plan","70.10%","0.682928621768951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$900","$200","$100","$1,600","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-03","Limited Cost Sharing Plan Variation","71.90%","0.701062917709351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$800","$200","$100","$1,200","$0","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-04","73% AV Level Silver Plan","74.00%","0.720932364463806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$800","$200","$100","$1,200","$0","$80","7"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-05","87% AV Level Silver Plan","87.10%","0.859683871269226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$900","$200","$0","$1,100","$30","$80","8"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050004","KP GA Silver 1500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050004-06","94% AV Level Silver Plan","93.90%","0.92780464887619","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$200","$200","$0","$400","$10","$80","9"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-01","Standard Silver On Exchange Plan","70.00%","0.682204008102417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$500","$200","$100","$1,200","$0","$80","10"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","11"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-03","Limited Cost Sharing Plan Variation","70.00%","0.682204008102417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$500","$200","$100","$1,200","$0","$80","12"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-04","73% AV Level Silver Plan","74.00%","0.720932364463806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$800","$200","$100","$1,200","$0","$80","13"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","3","89942","GA","Individual","No","58-1592076","89942GA0050005","KP GA Silver 2500/30","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050005-05","87% AV Level Silver Plan","87.10%","0.859683871269226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$900","$200","$0","$1,100","$30","$80","14"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","4","89942","GA","Individual","No","58-1592076","89942GA0050006","KP GA Silver 1750/25%/HSA","89942GA005",,"GAN001","GAS002","GAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050006-05","87% AV Level Silver Plan","87.00%","0.857164978981018","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$10","$400","$200","$500","$400","$50","$80","8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710015","Humana Connect Basic 6350/6350 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103868","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058498","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710015","Humana Connect Basic 6350/6350 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103868","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058498","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-03","Limited Cost Sharing Plan Variation","70.57%","0.710566699504852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700001","Anthem Bronze DirectAccess - caaa","17575IN070",,"INN001","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6E","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","No","35-0781558","17575IN0700007","Anthem Bronze DirectAccess w/Child Dental - cdaa","17575IN070",,"INN002","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.sbc.anthem.com/dps/CCD0S6F","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700007-01","Standard Bronze On Exchange Plan","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0810001","Anthem Dental Pediatric","17575IN081",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212885.pdf",,,,"17575IN0810001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","Yes","35-0781558","17575IN0840001","Anthem Dental Pediatric","17575IN084",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212885.pdf",,,,"17575IN0840001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720002","Anthem Silver Direct Access Plus gcpa","17575IN072",,"INN002","INS001","INF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990701028715785",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0720002-01","Standard Silver On Exchange Plan","68.31%","0.683839201927185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","$3,000","$6,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$3,000","$20","$850","$150","$3,000","$420","$120","$80","4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0810001","Anthem Dental Pediatric","17575IN081",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212885.pdf",,,,"17575IN0810001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710006-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710007","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710007-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710007","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710007","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710007-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060007","KP GA Silver HDHP/2000/20/S1","89942GA006",,"GAN001","GAS001","GAF016","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060007-01","Standard Silver On Exchange Plan","68.50%","0.671124160289764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$500","$200","$2,000","$0","$600","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","Individual","No","58-1592076","89942GA0050007","KP GA Bronze 5000/50","89942GA005",,"GAN001","GAS002","GAF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060008","KP GA Bronze  HDHP/4000/25/S1","89942GA006",,"GAN001","GAS001","GAF013","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060008-01","Standard Bronze On Exchange Plan","60.90%","0.603454947471619","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$70","$200","$4,000","$0","$300","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060009","KP GA Bronze HDHP/4500/40/S1","89942GA006",,"GAN001","GAS001","GAF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060009-01","Standard Bronze On Exchange Plan","59.10%","0.588097870349884","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$0","$0","$200","$4,500","$0","$200","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060010","KP GA Gold HDHP/2000/40/S1","89942GA006",,"GAN001","GAS001","GAF014","New","HMO","Gold","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"Yes","Yes","$1,500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060010-01","Standard Gold On Exchange Plan","78.80%","0.780615448951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$900","$200","$2,000","$0","$1,200","$80","7"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","5","89942","GA","SHOP (Small Group)","No","58-1592076","89942GA0060011","KP GA Silver HDHP/2000/40/S1","89942GA006",,"GAN001","GAS001","GAF014","New","HMO","Silver","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care Only","Yes","Urgent and Emergency Care Only","No","http://info.kp.org/healthplans/georgia/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/ga/plans/smallbusiness","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0060011-01","Standard Silver On Exchange Plan","70.70%","0.699244856834412","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$900","$200","$2,000","$0","$1,200","$80","8"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","7","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 5000/30%/HSA","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050009-01","Standard Bronze On Exchange Plan","58.50%","0.581887781620026","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$20","$0","$200","$1,000","$1,200","$0","$80","4"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","7","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 5000/30%/HSA","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","7","89942","GA","Individual","No","58-1592076","89942GA0050009","KP GA Bronze 5000/30%/HSA","89942GA005",,"GAN001","GAS002","GAF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","0","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050009-03","Limited Cost Sharing Plan Variation","58.50%","0.581887781620026","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$20","$0","$200","$1,000","$1,200","$0","$80","6"
"2014","GA","89942","HIOS","7","2014-01-17 09:36:20","8","89942","GA","Individual","No","58-1592076","89942GA0050010","KP GA Catastrophic 6350/0","89942GA005",,"GAN001","GAS002","GAF006","New","HMO","Catastrophic","No","On the Exchange","No","Yes","Allergy & Immunology, Anesthesiology, Audiology, Cardiology, Colon & Rectal Surgery, Critical Care Medicine, Endocrinology/Metabolism, Gastroenterology, General Surgery, Gynecologic Oncology, Hand Surgery, Hematology, Hematology/Oncology, Hyperbaric Medicine, Infectious Diseases, Infertility, Maternal & Fetal Medicine, Nephrology, Neurology, Neurosurgery, Occupational Therapy, Oncology, Oral & Maxillofacial Surgery, Otolaryngology, Pain Management, Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Hematology/Oncology, Pediatric Infectious Diseases, Pediatric Nephrology, Pediatric Neurology, Pediatric Neurosurgery, Pediatric Otolaryngology, Pediatric Pulmonology, Pediatric Surgery, Pediatric Urology, Physical Medicine & Rehabilitation, Physical Therapy, Plastic Surgery, Podiatry, Pulmonary Disease, Radiation Oncology, Sleep Disorders, Sports Medicine, Thoracic Surgery, Urology and Vascular Surgery",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993",,,"0","3","0","2014-01-01",,"Yes","Urgent and Emergency Care only","Yes","Urgent and Emergency Care only","No","http://info.kp.org/healthplans/georgia/individual/summary-benefits-coverage","https://www.billerpayments.com/saml/hix/kpgabp","https://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs/georgia-health-plan-coverage-and-costs.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9Ld3RFsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCZW6Db/","89942GA0050010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,300","$0","$0","$200","$4,793","$0","$0","$80","4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710004","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN001","GAS002","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710006-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710006-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710006","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN001","GAS002","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710018","Humana Connect Silver 4600/6300 Plan","93332GA071",,"GAN002","GAS003","GAF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103907","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058524","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710018-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710020-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710020-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710020","Humana Connect Gold 2500/3500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103946","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058576","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710021","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710021-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710021","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","1","93332","GA","Individual","No","58-2209549","93332GA0710021","Humana Connect Platinum 1000/1500 Plan","93332GA071",,"GAN002","GAS003","GAF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103959","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058602","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710021-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-05","87% AV Level Silver Plan","86.32%","0.865209221839905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-06","94% AV Level Silver Plan","93.23%","0.933509588241577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","8","17575","IN","Individual","No","35-0781558","17575IN0700014","Anthem Catastrophic DirectAccess","17575IN070",,"INN001","INS001","INF004","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S7H","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010002","Ambetter Gold 2","35065IN001",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010002","Ambetter Gold 2","35065IN001",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010002","Ambetter Gold 2","35065IN001",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010005","Ambetter Silver 1","35065IN001",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710001","Humana Connect Basic 6350/6350 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103868","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058498","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710001","Humana Connect Basic 6350/6350 Plan","93332GA071",,"GAN001","GAS002","GAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103868","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058498","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","Yes","35-0781558","17575IN0840001","Anthem Dental Pediatric","17575IN084",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212885.pdf",,,,"17575IN0840001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","Yes","35-0781558","17575IN0840002","Anthem Dental Pediatric Enhanced","17575IN084",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e213346.pdf",,,,"17575IN0840002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0810002","Anthem Dental Pediatric Enhanced","17575IN081",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e213346.pdf",,,,"17575IN0810002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700003","Anthem Bronze DirectAccess - caae","17575IN070",,"INN001","INS001","INF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8S","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700003","Anthem Bronze DirectAccess - caae","17575IN070",,"INN001","INS001","INF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8S","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700003-03","Limited Cost Sharing Plan Variation","60.28%","0.62304824590683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700001","Anthem Bronze DirectAccess - caaa","17575IN070",,"INN001","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6E","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700001-03","Limited Cost Sharing Plan Variation","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720001","Anthem Bronze DirectAccess Plus-gjqa","17575IN072",,"INN002","INS001","INF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989692564425194",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0720001-01","Standard Bronze On Exchange Plan","58.72%","0","No","No","No","100%",,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$5,000","$520","$0","$150","$5,000","$50","$40","$80","4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700012","Anthem Gold DirectAccess - ccab","17575IN070",,"INN001","INS001","INF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T23","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700012-01","Standard Gold On Exchange Plan","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700012","Anthem Gold DirectAccess - ccab","17575IN070",,"INN001","INS001","INF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T23","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700012","Anthem Gold DirectAccess - ccab","17575IN070",,"INN001","INS001","INF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T23","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700012-03","Limited Cost Sharing Plan Variation","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-01","Standard Silver On Exchange Plan","70.30%","0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-03","Limited Cost Sharing Plan Variation","70.30%","0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-04","73% AV Level Silver Plan","72.33%","0.723338723182678","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-05","87% AV Level Silver Plan","86.15%","0.86151123046875","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710016-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","2","93332","GA","Individual","No","58-2209549","93332GA0710016","Humana Connect Bronze 6300/6300 Plan","93332GA071",,"GAN002","GAS003","GAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103881","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057913","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0710016-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana National Preferred Bronze 6300/6300 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104011","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058641","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830002","Anthem Dental Family Enhanced","17575IN083",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212884.pdf",,,,"17575IN0830002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","Individual","Yes","35-0781558","17575IN0860002","Anthem Dental Family Enhanced","17575IN086",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212884.pdf",,,,"17575IN0860002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","2","17575","IN","SHOP (Small Group)","Yes","35-0781558","17575IN0830002","Anthem Dental Family Enhanced","17575IN083",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/in/f0/s0/t0/pw_e212884.pdf",,,,"17575IN0830002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-00","Standard Silver Off Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-01","Standard Silver On Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-03","Limited Cost Sharing Plan Variation","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-04","73% AV Level Silver Plan","72.51%","0.725123465061188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-05","87% AV Level Silver Plan","86.33%","0.863307356834412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720004","Humana National Preferred Silver 4250/6250 Plan","93332GA072",,"GAN004","GAS001","GAF007","New","POS","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104037","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058693","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720004-06","94% AV Level Silver Plan","93.72%","0.937241017818451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$250","$500","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana National Preferred Gold 2500/3500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104063","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058745","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720006-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana National Preferred Gold 2500/3500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104063","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058745","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720006-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720006","Humana National Preferred Gold 2500/3500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104063","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058745","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720007","Humana National Preferred Platinum 1000/1500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104076","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058771","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720007-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","3","93332","GA","Individual","No","58-2209549","93332GA0720007","Humana National Preferred Platinum 1000/1500 Plan","93332GA072",,"GAN004","GAS001","GAF008","New","POS","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104076","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058771","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0720007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-03","Limited Cost Sharing Plan Variation","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-04","73% AV Level Silver Plan","72.75%","0.732995271682739","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720001","Humana National Preferred Basic 6350/6350 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103972","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058628","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720001","Humana National Preferred Basic 6350/6350 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2103972","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058628","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana National Preferred Bronze 6300/6300 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104011","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058641","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana National Preferred Bronze 6300/6300 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104011","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058641","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010009","Ambetter Silver 5","35065IN001",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010004","Ambetter Gold 4","35065IN001",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010004","Ambetter Gold 4","35065IN001",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010004","Ambetter Gold 4","35065IN001",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010010","Ambetter Bronze 1","35065IN001",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","4","93332","GA","Individual","No","58-2209549","93332GA0720002","Humana National Preferred Bronze 6300/6300 Plan","93332GA072",,"GAN004","GAS001","GAF005","New","POS","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104011","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058641","http://apps.humana.com/marketing/documents.asp?file=2067338","93332GA0720002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN001","GAS002","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN001","GAS002","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN001","GAS002","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710003","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN001","GAS002","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN002","GAS003","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710017-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN002","GAS003","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710017-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN002","GAS003","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","GA","93332","HIOS","8","2014-01-16 07:24:04","5","93332","GA","Individual","No","58-2209549","93332GA0710017","Humana Connect Bronze 4850/6350 Plan","93332GA071",,"GAN002","GAS003","GAF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner, Dermatologist and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2103894","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057939","http://apps.humana.com/marketing/documents.asp?file=2067403","93332GA0710017-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","3","17575","IN","Individual","No","35-0781558","17575IN0700009","Anthem Silver DirectAccess - cbki","17575IN070",,"INN001","INS001","INF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6X","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700009-01","Standard Silver On Exchange Plan","70.57%","0.710566699504852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","Individual","No","35-0781558","17575IN0700007","Anthem Bronze DirectAccess w/Child Dental - cdaa","17575IN070",,"INN002","INS001","INF019","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.sbc.anthem.com/dps/CCD0S6F","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","1","17575","IN","SHOP (Small Group)","No","35-0781558","17575IN0720007","Anthem Silver DirectAccess Plus-gfpa","17575IN072",,"INN002","INS001","INF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.991027652009941",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0720007-01","Standard Silver On Exchange Plan","69.39%","0.695959091186523","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,000","$60","$1,520","$150","$2,000","$610","$280","$80","5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","4","17575","IN","Individual","No","35-0781558","17575IN0700008","Anthem Silver DirectAccess - cbaa","17575IN070",,"INN001","INS001","INF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6T","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700008-06","94% AV Level Silver Plan","93.26%","0.932569682598114","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700004","Anthem Bronze DirectAccess w/HSA - caar","17575IN070",,"INN001","INS001","INF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6J","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700004-01","Standard Bronze On Exchange Plan","58.16%","0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700004","Anthem Bronze DirectAccess w/HSA - caar","17575IN070",,"INN001","INS001","INF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6J","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700004","Anthem Bronze DirectAccess w/HSA - caar","17575IN070",,"INN001","INS001","INF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6J","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700004-03","Limited Cost Sharing Plan Variation","58.16%","0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-01","Standard Silver On Exchange Plan","69.15%","0.688681662082672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-03","Limited Cost Sharing Plan Variation","69.15%","0.688681662082672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-04","73% AV Level Silver Plan","72.80%","0.731756865978241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-05","87% AV Level Silver Plan","86.17%","0.862436950206757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700011","Anthem Silver DirectAccess w/HSA - cbbg","17575IN070",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S75","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700011-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700005","Anthem Bronze DirectAccess w/HSA - cabm","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8U","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700005-01","Standard Bronze On Exchange Plan","59.99%","0.602794587612152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700005","Anthem Bronze DirectAccess w/HSA - cabm","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8U","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","5","17575","IN","Individual","No","35-0781558","17575IN0700005","Anthem Bronze DirectAccess w/HSA - cabm","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0X8U","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700005-03","Limited Cost Sharing Plan Variation","59.99%","0.602794587612152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0700002","Anthem Bronze DirectAccess - cabr","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6G","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700002-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0700002","Anthem Bronze DirectAccess - cabr","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6G","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0700002","Anthem Bronze DirectAccess - cabr","17575IN070",,"INN001","INS001","INF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6G","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700002-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0760001","Anthem Bronze DirectAccess - caca","17575IN076",,"INN001","INS001","INF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6R","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0760001-01","Standard Bronze On Exchange Plan","59.89%","0.60009640455246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$30,000","$60,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0760001","Anthem Bronze DirectAccess - caca","17575IN076",,"INN001","INS001","INF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6R","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0760001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","6","17575","IN","Individual","No","35-0781558","17575IN0760001","Anthem Bronze DirectAccess - caca","17575IN076",,"INN001","INS001","INF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S6R","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0760001-03","Limited Cost Sharing Plan Variation","59.89%","0.60009640455246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$30,000","$60,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-01","Standard Silver On Exchange Plan","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","HIOS","12","2014-03-19 07:06:49","7","17575","IN","Individual","No","35-0781558","17575IN0700010","Anthem Silver DirectAccess - cbds","17575IN070",,"INN001","INS001","INF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0S71","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0700010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","1","35065","IN","Individual","No","39-1821211","35065IN0010007","Ambetter Silver 3","35065IN001",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010010","Ambetter Bronze 1","35065IN001",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010010","Ambetter Bronze 1","35065IN001",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010012","Ambetter Bronze 3","35065IN001",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010012","Ambetter Bronze 3","35065IN001",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010012","Ambetter Bronze 3","35065IN001",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010013","Ambetter Bronze 4","35065IN001",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010013","Ambetter Bronze 4","35065IN001",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","2","35065","IN","Individual","No","39-1821211","35065IN0010013","Ambetter Bronze 4","35065IN001",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","3","35065","IN","Individual","No","39-1821211","35065IN0010008","Ambetter Silver 4","35065IN001",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0010008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020002","Ambetter Gold 2 + Vision","35065IN002",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020002","Ambetter Gold 2 + Vision","35065IN002",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020002","Ambetter Gold 2 + Vision","35065IN002",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020005","Ambetter Silver 1 + Vision","35065IN002",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020007","Ambetter Silver 3 + Vision","35065IN002",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","4","35065","IN","Individual","No","39-1821211","35065IN0020009","Ambetter Silver 5 + Vision","35065IN002",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020004","Ambetter Gold 4 + Vision","35065IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020004","Ambetter Gold 4 + Vision","35065IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020004","Ambetter Gold 4 + Vision","35065IN002",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020010","Ambetter Bronze 1 + Vision","35065IN002",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020010","Ambetter Bronze 1 + Vision","35065IN002",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020010","Ambetter Bronze 1 + Vision","35065IN002",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020012","Ambetter Bronze 3 + Vision","35065IN002",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020012","Ambetter Bronze 3 + Vision","35065IN002",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020012","Ambetter Bronze 3 + Vision","35065IN002",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020013","Ambetter Bronze 4 + Vision","35065IN002",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020013","Ambetter Bronze 4 + Vision","35065IN002",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","5","35065","IN","Individual","No","39-1821211","35065IN0020013","Ambetter Bronze 4 + Vision","35065IN002",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","6","35065","IN","Individual","No","39-1821211","35065IN0020008","Ambetter Silver 4 + Vision","35065IN002",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.985",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0020008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030002","Ambetter Gold 2 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030002","Ambetter Gold 2 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030002","Ambetter Gold 2 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030005","Ambetter Silver 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030007","Ambetter Silver 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","7","35065","IN","Individual","No","39-1821211","35065IN0030009","Ambetter Silver 5 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030004","Ambetter Gold 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030004","Ambetter Gold 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030004","Ambetter Gold 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030010","Ambetter Bronze 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030010","Ambetter Bronze 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030010","Ambetter Bronze 1 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030012","Ambetter Bronze 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030012","Ambetter Bronze 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030012","Ambetter Bronze 3 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030013","Ambetter Bronze 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030013","Ambetter Bronze 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","8","35065","IN","Individual","No","39-1821211","35065IN0030013","Ambetter Bronze 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","IN","35065","HIOS","4","2013-08-30 07:44:10","9","35065","IN","Individual","No","39-1821211","35065IN0030008","Ambetter Silver 4 + Vision + Adult Dental","35065IN003",,"INN001","INS001","INF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9433",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.mhsindiana.com/benefits","http://ambetter.mhsindiana.com/payments","http://ambetter.mhsindiana.com/ourplans","http://ambetter.mhsindiana.com/formulary","35065IN0030008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","1","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070001","Pediatric Plan 1","43499IN007",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","1","43499","IN","Individual","Yes","34-0648820","43499IN0060001","Pediatric Plan 1","43499IN006",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0060001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","1","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070002","Pediatric Plan 2","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070002-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","2","43499","IN","Individual","Yes","34-0648820","43499IN0060002","Dental Plan 1","43499IN006",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0060002-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","2","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070003","Plan 1","43499IN007",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070003-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","2","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070005","Plan 3","43499IN007",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070005-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","2","43499","IN","Individual","Yes","34-0648820","43499IN0060003","Dental Plan 2","43499IN006",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0060003-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","3","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070004","Plan 2 - Ortho","43499IN007",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070004-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","3","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070006","Plan 4 - Ortho","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070006-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","3","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070007","Plan 5 - Ortho","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070007-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","3","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070008","Plan 6 - Ortho","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070008-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","3","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070009","Plan 7 - Ortho","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070009-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","4","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070010","Plan 2","43499IN007",,"INN001","INS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070010-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","4","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070011","Plan 4","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070011-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","4","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070012","Plan 5","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070012-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","4","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070013","Plan 6","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070013-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","43499","HIOS","1","2013-06-28 08:36:25","4","43499","IN","SHOP (Small Group)","Yes","34-0648820","43499IN0070014","Plan 7","43499IN007",,"INN001","INS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"43499IN0070014-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","1","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0020001","Managed DentalGuard IN Child Essentials 1","45958IN002",,"INN001","INS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0020001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","1","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0020001","Managed DentalGuard IN Child Essentials 1","45958IN002",,"INN001","INS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0020001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","1","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0010001","Managed DentalGuard IN Child Essentials 2","45958IN001",,"INN001","INS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.01",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0010001-00","Standard High Off Exchange Plan","83.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","1","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0010001","Managed DentalGuard IN Child Essentials 2","45958IN001",,"INN001","INS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.01",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0010001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","2","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0030001","Managed DentalGuard IN10 Family Plan","45958IN003",,"INN001","INS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0030001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","2","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0030001","Managed DentalGuard IN10 Family Plan","45958IN003",,"INN001","INS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0030001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","2","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0040001","Managed DentalGuard IN20 Family Plan","45958IN004",,"INN001","INS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0040001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","45958","HIOS","4","2013-09-02 11:39:25","2","45958","IN","SHOP (Small Group)","Yes","36-3691770","45958IN0050001","Managed DentalGuard IN30 Family Plan","45958IN005",,"INN001","INS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.60",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"45958IN0050001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-00","Standard Silver Off Exchange Plan","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,400","$200","$1,300","$1,100","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","Yes","31-1069321","50816IN0190001","Dental Basic","50816IN019","7831192068","INN003","INS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"50816IN0190001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110001","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP01-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110001-00","Standard Platinum Off Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-01","Standard Silver On Exchange Plan","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,400","$200","$1,300","$1,100","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","Yes","31-1069321","50816IN0190002","Dental Value","50816IN019","7831192068","INN003","INS001",,"New","HMO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"50816IN0190002-00","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110001","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP01-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110001-01","Standard Platinum On Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","Yes","31-1069321","50816IN0190004","Dental Value Plus","50816IN019","7831192068","INN003","INS001",,"New","HMO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"50816IN0190004-00","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110002","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP02-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110002-00","Standard Platinum Off Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110002","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP02-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110002-01","Standard Platinum On Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-03","Limited Cost Sharing Plan Variation","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,400","$200","$1,300","$1,100","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110003","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP03-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110003-00","Standard Platinum Off Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-04","73% AV Level Silver Plan","73.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$0","$1,700","$200","$1,300","$1,100","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110003","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP03-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110003-01","Standard Platinum On Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-05","87% AV Level Silver Plan","87.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$700","$200","$500","$1,000","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110004","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP04-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110004-00","Standard Gold Off Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","Individual","No","31-1069321","50816IN0150001","Marquee 2500","50816IN015","7831192068","INN002","INS001","INF010","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0150001-06","94% AV Level Silver Plan","94.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$300","$200","$100","$300","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110004","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP04-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110004-01","Standard Gold On Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110005","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP05-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110005-00","Standard Gold Off Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","12"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110005","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP05-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110005-01","Standard Gold On Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","13"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110006","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP06-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110006-00","Standard Gold Off Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","14"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110006","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP06-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110006-01","Standard Gold On Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","15"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110007","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP07-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110007-00","Standard Gold Off Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","16"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110007","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP07-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110007-01","Standard Gold On Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","17"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110008","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP08-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110008-00","Standard Gold Off Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","18"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110008","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP08-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110008-01","Standard Gold On Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","19"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110009","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP09-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110009-00","Standard Gold Off Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","20"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110009","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP09-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110009-01","Standard Gold On Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","21"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110010","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP10-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110010-00","Standard Gold Off Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","22"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110010","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP10-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110010-01","Standard Gold On Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","23"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110011","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP11-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110011-00","Standard Silver Off Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","24"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110011","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP11-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110011-01","Standard Silver On Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","25"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110012","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP12-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110012-00","Standard Silver Off Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","26"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110012","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP12-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110012-01","Standard Silver On Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","27"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110013","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP13-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110013-00","Standard Silver Off Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","28"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110013","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP13-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110013-01","Standard Silver On Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","29"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110014","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP14-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110014-00","Standard Silver Off Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","30"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110014","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP14-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110014-01","Standard Silver On Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","31"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110015","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP15-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110015-00","Standard Silver Off Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","32"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110015","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP15-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110015-01","Standard Silver On Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","33"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110016","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS16-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110016-00","Standard Platinum Off Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","34"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110016","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS16-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110016-01","Standard Platinum On Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","35"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110017","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS17-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110017-00","Standard Platinum Off Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","36"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110017","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS17-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110017-01","Standard Platinum On Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","37"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110018","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS18-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110018-00","Standard Platinum Off Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","38"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110018","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS18-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110018-01","Standard Platinum On Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","39"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110019","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS19-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110019-00","Standard Gold Off Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","40"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110019","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS19-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110019-01","Standard Gold On Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","41"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110020","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS20-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110020-00","Standard Gold Off Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","42"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110020","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS20-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110020-01","Standard Gold On Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","43"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110021","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS21-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110021-00","Standard Gold Off Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","44"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110021","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS21-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110021-01","Standard Gold On Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","45"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110022","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS22-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110022-00","Standard Gold Off Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","46"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110022","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS22-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110022-01","Standard Gold On Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","47"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110023","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS23-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110023-00","Standard Gold Off Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","48"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110023","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS23-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110023-01","Standard Gold On Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","49"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110024","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS24-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110024-00","Standard Gold Off Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","50"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110024","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS24-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110024-01","Standard Gold On Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","51"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110025","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS25-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110025-00","Standard Gold Off Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","52"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110025","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS25-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110025-01","Standard Gold On Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","53"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110026","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS26-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110026-00","Standard Silver Off Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","54"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110026","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS26-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110026-01","Standard Silver On Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","55"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110027","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS27-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110027-00","Standard Silver Off Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","56"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110027","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS27-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110027-01","Standard Silver On Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","57"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110028","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS28-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110028-00","Standard Silver Off Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","58"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110028","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS28-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110028-01","Standard Silver On Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","59"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110029","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS29-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110029-00","Standard Silver Off Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","60"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110029","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS29-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110029-01","Standard Silver On Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","61"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110030","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS30-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110030-00","Standard Silver Off Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","62"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","1","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110030","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS30-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110030-01","Standard Silver On Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","63"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110031","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP31-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110031-00","Standard Silver Off Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","Yes","31-1069321","50816IN0190003","Dental Value with Ortho","50816IN019","7831192068","INN003","INS001",,"New","HMO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"50816IN0190003-00","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","$25","$25","$25",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170001","Marquee 6000","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170001-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,300","$0","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","Yes","31-1069321","50816IN0190005","Dental Value Plus with Ortho","50816IN019","7831192068","INN003","INS001",,"New","HMO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"50816IN0190005-00","Standard High Off Exchange Plan","85.63%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","$25","$25","$25",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110031","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP31-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110031-01","Standard Silver On Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170001","Marquee 6000","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170001-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,300","$0","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110032","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP32-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110032-00","Standard Silver Off Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170001","Marquee 6000","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170001","Marquee 6000","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170001-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,300","$0","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110032","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP32-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110032-01","Standard Silver On Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110033","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS33-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110033-00","Standard Silver Off Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170002","Marquee 5000","50816IN017","7831192068","INN002","INS001","INF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170002-00","Standard Bronze Off Exchange Plan",,"0.601755023002625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$200","$200","$5,000","$0","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110033","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS33-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110033-01","Standard Silver On Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170002","Marquee 5000","50816IN017","7831192068","INN002","INS001","INF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170002-01","Standard Bronze On Exchange Plan",,"0.601755023002625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$200","$200","$5,000","$0","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170002","Marquee 5000","50816IN017","7831192068","INN002","INS001","INF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110034","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS34-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110034-00","Standard Silver Off Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110034","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS34-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110034-01","Standard Silver On Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170002","Marquee 5000","50816IN017","7831192068","INN002","INS001","INF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB2E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170002-03","Limited Cost Sharing Plan Variation",,"0.601755023002625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$200","$200","$5,000","$0","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170004","Marquee 4000","50816IN017","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB3E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170004-00","Standard Bronze Off Exchange Plan",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$1,000","$200","$4,000","$0","$400","$0","16"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170004","Marquee 4000","50816IN017","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB3E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170004-01","Standard Bronze On Exchange Plan",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$1,000","$200","$4,000","$0","$400","$0","17"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170004","Marquee 4000","50816IN017","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB3E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","18"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170004","Marquee 4000","50816IN017","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB3E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170004-03","Limited Cost Sharing Plan Variation",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$1,000","$200","$4,000","$0","$400","$0","19"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170006","Marquee 3000","50816IN017","7831192068","INN002","INS001","INF007","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB4E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170006-00","Standard Bronze Off Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$1,700","$200","$3,000","$0","$900","$0","24"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170006","Marquee 3000","50816IN017","7831192068","INN002","INS001","INF007","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB4E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170006-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$1,700","$200","$3,000","$0","$900","$0","25"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170006","Marquee 3000","50816IN017","7831192068","INN002","INS001","INF007","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB4E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","26"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170006","Marquee 3000","50816IN017","7831192068","INN002","INS001","INF007","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHB4E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170006-03","Limited Cost Sharing Plan Variation",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$1,700","$200","$3,000","$0","$900","$0","27"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170008","Marquee 1000","50816IN017","7831192068","INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHG1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170008-00","Standard Gold Off Exchange Plan",,"0.781180679798126","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$0","$1,300","$200","$1,000","$0","$900","$0","32"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170008","Marquee 1000","50816IN017","7831192068","INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHG1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170008-01","Standard Gold On Exchange Plan",,"0.781180679798126","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$0","$1,300","$200","$1,000","$0","$900","$0","33"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170008","Marquee 1000","50816IN017","7831192068","INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHG1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","34"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170008","Marquee 1000","50816IN017","7831192068","INN002","INS001","INF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHG1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170008-03","Limited Cost Sharing Plan Variation",,"0.781180679798126","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$0","$1,300","$200","$1,000","$0","$900","$0","35"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170009","Marquee 6350","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHC1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170009-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$200","$4,900","$0","$0","$0","36"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170009","Marquee 6350","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHC1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$200","$4,900","$0","$0","$0","37"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-00","Standard Silver Off Exchange Plan","68.46%","0.632905066013336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$500","$0","$0","40"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-01","Standard Silver On Exchange Plan","68.46%","0.632905066013336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$500","$0","$0","41"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","42"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-03","Limited Cost Sharing Plan Variation","68.46%","0.632905066013336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$500","$0","$0","43"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-04","73% AV Level Silver Plan","73.89%","0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,650","$0","$0","$200","$2,650","$0","$0","$0","44"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-05","87% AV Level Silver Plan","87.65%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$0","$0","$200","$1,000","$0","$0","$0","45"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","2","50816","IN","Individual","No","31-1069321","50816IN0170011","Marquee 3500","50816IN017","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/individual/sbc?planid=IHS1E14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/individualbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0170011-06","94% AV Level Silver Plan","94.49%","0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$0","$0","$200","$400","$0","$0","$0","46"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130001","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130001-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130001","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130001-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130002","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130002-00","Standard Silver Off Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130002","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130002-01","Standard Silver On Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130003","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130003-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130003","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130003-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130004","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130004-00","Standard Silver Off Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130004","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130004-01","Standard Silver On Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130005","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130005-00","Standard Silver Off Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","12"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130005","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130005-01","Standard Silver On Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","13"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130006","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130006-00","Standard Silver Off Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","14"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130006","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130006-01","Standard Silver On Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","15"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130007","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130007-00","Standard Silver Off Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","16"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130007","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130007-01","Standard Silver On Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","17"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130008","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130008-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","18"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130008","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130008-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","19"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130009","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130009-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","20"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130009","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP0914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130009-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","21"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130010","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130010-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","22"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130010","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130010-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","23"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130011","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130011-00","Standard Bronze Off Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","24"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130011","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130011-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","25"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130012","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130012-00","Standard Bronze Off Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","26"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130012","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130012-01","Standard Bronze On Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","27"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130013","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130013-00","Standard Bronze Off Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","28"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130013","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130013-01","Standard Bronze On Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","29"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130014","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130014-00","Standard Bronze Off Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","30"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130014","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP1414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130014-01","Standard Bronze On Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","31"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130015","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130015-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","32"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130015","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130015-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","33"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130016","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130016-00","Standard Silver Off Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","34"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130016","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130016-01","Standard Silver On Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","35"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130017","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130017-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","36"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130017","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130017-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","37"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130018","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130018-00","Standard Silver Off Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","38"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130018","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130018-01","Standard Silver On Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","39"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130019","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130019-00","Standard Silver Off Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","40"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130019","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS1914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130019-01","Standard Silver On Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","41"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130020","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130020-00","Standard Silver Off Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","42"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130020","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130020-01","Standard Silver On Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","43"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130021","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130021-00","Standard Silver Off Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","44"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130021","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130021-01","Standard Silver On Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","45"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130022","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130022-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","46"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130022","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130022-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","47"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130023","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130023-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","48"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130023","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130023-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","49"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130024","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130024-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","50"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130024","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130024-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","51"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130025","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130025-00","Standard Bronze Off Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","52"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130025","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130025-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","53"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130026","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130026-00","Standard Bronze Off Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","54"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130026","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130026-01","Standard Bronze On Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","55"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130027","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130027-00","Standard Bronze Off Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","56"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130027","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130027-01","Standard Bronze On Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","57"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130028","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130028-00","Standard Bronze Off Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","58"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130028","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS2814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130028-01","Standard Bronze On Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","59"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130057","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP5714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130057-00","Standard Gold Off Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","60"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130057","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP5714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130057-01","Standard Gold On Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","61"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130058","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130058-00","Standard Gold Off Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","62"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","3","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130058","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130058-01","Standard Gold On Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","63"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110035","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP35-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110035-00","Standard Platinum Off Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110035","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP35-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110035-01","Standard Platinum On Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110036","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP36-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110036-00","Standard Platinum Off Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110036","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP36-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110036-01","Standard Platinum On Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110037","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP37-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110037-00","Standard Platinum Off Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110037","Classic Premier","50816IN011","7831192068","INN001","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP37-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110037-01","Standard Platinum On Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110038","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP38-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110038-00","Standard Gold Off Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110038","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP38-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110038-01","Standard Gold On Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110039","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP39-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110039-00","Standard Gold Off Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","12"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110039","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP39-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110039-01","Standard Gold On Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","13"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110040","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP40-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110040-00","Standard Gold Off Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","14"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110040","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP40-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110040-01","Standard Gold On Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","15"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110041","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP41-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110041-00","Standard Gold Off Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","16"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110041","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP41-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110041-01","Standard Gold On Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","17"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110042","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP42-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110042-00","Standard Gold Off Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","18"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110042","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP42-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110042-01","Standard Gold On Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","19"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110043","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP43-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110043-00","Standard Gold Off Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","20"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110043","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP43-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110043-01","Standard Gold On Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","21"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110044","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP44-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110044-00","Standard Gold Off Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","22"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110044","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP44-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110044-01","Standard Gold On Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","23"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110045","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP45-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110045-00","Standard Silver Off Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","24"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110045","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP45-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110045-01","Standard Silver On Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","25"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110046","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP46-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110046-00","Standard Silver Off Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","26"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110046","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP46-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110046-01","Standard Silver On Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","27"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110047","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP47-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110047-00","Standard Silver Off Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","28"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110047","Classic Premier","50816IN011","7831192068","INN001","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP47-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110047-01","Standard Silver On Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","29"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110048","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP48-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110048-00","Standard Silver Off Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","30"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110048","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP48-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110048-01","Standard Silver On Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","31"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110049","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP49-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110049-00","Standard Silver Off Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","32"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110049","Classic Premier","50816IN011","7831192068","INN001","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP49-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110049-01","Standard Silver On Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","33"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110050","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS50-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110050-00","Standard Platinum Off Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","34"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110050","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS50-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110050-01","Standard Platinum On Exchange Plan",,"0.881292045116425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,200","$0","$0","35"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110051","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS51-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110051-00","Standard Platinum Off Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","36"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110051","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS51-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110051-01","Standard Platinum On Exchange Plan",,"0.895299136638641","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,300","$0","$0","37"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110052","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS52-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110052-00","Standard Platinum Off Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","38"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110052","Classic Select","50816IN011","7831192068","INN002","INS001","INF008","New","HMO","Platinum","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS52-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110052-01","Standard Platinum On Exchange Plan",,"0.897770345211029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$20","$1,300","$200","$200","$1,200","$0","$0","39"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110053","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS53-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110053-00","Standard Gold Off Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","40"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110053","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS53-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110053-01","Standard Gold On Exchange Plan",,"0.78375232219696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,100","$200","$200","$1,400","$0","$0","41"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110054","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS54-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110054-00","Standard Gold Off Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","42"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110054","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS54-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110054-01","Standard Gold On Exchange Plan",,"0.782848834991455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","43"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110055","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS55-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110055-00","Standard Gold Off Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","44"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110055","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS55-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110055-01","Standard Gold On Exchange Plan",,"0.794867336750031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,200","$200","$200","$1,400","$0","$0","45"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110056","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS56-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110056-00","Standard Gold Off Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","46"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110056","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS56-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110056-01","Standard Gold On Exchange Plan",,"0.799361646175385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","47"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110057","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS57-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110057-00","Standard Gold Off Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","48"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110057","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS57-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110057-01","Standard Gold On Exchange Plan",,"0.809376001358032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","49"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110058","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS58-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110058-00","Standard Gold Off Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","50"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110058","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS58-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110058-01","Standard Gold On Exchange Plan",,"0.816635727882385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$200","$200","$1,400","$0","$0","51"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110059","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS59-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110059-00","Standard Gold Off Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","52"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110059","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Gold","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS59-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110059-01","Standard Gold On Exchange Plan",,"0.819654047489166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,400","$200","$200","$1,400","$0","$0","53"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110060","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS60-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110060-00","Standard Silver Off Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","54"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110060","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS60-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110060-01","Standard Silver On Exchange Plan",,"0.714377760887146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$20","$1,400","$200","$200","$2,000","$0","$0","55"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110061","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS61-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110061-00","Standard Silver Off Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","56"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110061","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS61-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110061-01","Standard Silver On Exchange Plan",,"0.718258440494537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$800","$200","$200","$1,700","$0","$0","57"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110062","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS62-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110062-00","Standard Silver Off Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","58"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110062","Classic Select","50816IN011","7831192068","INN002","INS001","INF009","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS62-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110062-01","Standard Silver On Exchange Plan","72.00%","0.720410645008087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,300","$200","$200","$1,700","$0","$0","59"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110063","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS63-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110063-00","Standard Silver Off Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","60"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110063","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS63-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110063-01","Standard Silver On Exchange Plan",,"0.719559848308563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$20","$600","$200","$200","$1,400","$0","$0","61"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110064","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS64-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110064-00","Standard Silver Off Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","62"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","4","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110064","Classic Select","50816IN011","7831192068","INN002","INS001","INF002","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS64-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110064-01","Standard Silver On Exchange Plan",,"0.719952762126923","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,600","$200","$200","$2,000","$0","$0","63"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110065","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP65-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110065-00","Standard Silver Off Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110065","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP65-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110065-01","Standard Silver On Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110066","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP66-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110066-00","Standard Silver Off Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110066","Classic Premier","50816IN011","7831192068","INN001","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HP66-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110066-01","Standard Silver On Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110067","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS67-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110067-00","Standard Silver Off Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110067","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS67-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110067-01","Standard Silver On Exchange Plan",,"0.698144316673279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$40","$900","$200","$1,200","$1,200","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110068","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS68-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110068-00","Standard Silver Off Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","5","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0110068","Classic Select","50816IN011","7831192068","INN002","INS001","INF001","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"No","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=HS68-14","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0110068-01","Standard Silver On Exchange Plan",,"0.713681221008301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$40","$1,600","$200","$1,200","$1,200","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130029","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP2914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130029-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130029","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP2914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130029-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","5"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130030","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130030-00","Standard Silver Off Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","6"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130030","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130030-01","Standard Silver On Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","7"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130031","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130031-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","8"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130031","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130031-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","9"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130032","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130032-00","Standard Silver Off Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","10"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130032","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130032-01","Standard Silver On Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","11"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130033","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130033-00","Standard Silver Off Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","12"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130033","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130033-01","Standard Silver On Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","13"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130034","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130034-00","Standard Silver Off Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","14"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130034","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130034-01","Standard Silver On Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","15"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130035","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130035-00","Standard Silver Off Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","16"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130035","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130035-01","Standard Silver On Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","17"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130036","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130036-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","18"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130036","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130036-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","19"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130037","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130037-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","20"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130037","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130037-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","21"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130038","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130038-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","22"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130038","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130038-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","23"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130039","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130039-00","Standard Bronze Off Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","24"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130039","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP3914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130039-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","25"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130040","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130040-00","Standard Bronze Off Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","26"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130040","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130040-01","Standard Bronze On Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","27"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130041","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130041-00","Standard Bronze Off Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","28"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130041","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130041-01","Standard Bronze On Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","29"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130042","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130042-00","Standard Bronze Off Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","30"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130042","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP4214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130042-01","Standard Bronze On Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","31"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130043","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130043-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","32"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130043","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130043-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","33"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130044","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130044-00","Standard Silver Off Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","34"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130044","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130044-01","Standard Silver On Exchange Plan",,"0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","35"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130045","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130045-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","36"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130045","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130045-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$0","$200","$3,000","$0","$0","$0","37"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130046","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130046-00","Standard Silver Off Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","38"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130046","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130046-01","Standard Silver On Exchange Plan","69.50%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$200","$3,500","$0","$0","$0","39"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130047","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130047-00","Standard Silver Off Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","40"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130047","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4714","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130047-01","Standard Silver On Exchange Plan","69.70%","0.692273139953613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$200","$2,500","$0","$500","$0","41"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130048","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130048-00","Standard Silver Off Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","42"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130048","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4814","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130048-01","Standard Silver On Exchange Plan","70.30%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$200","$2,000","$0","$600","$0","43"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130049","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130049-00","Standard Silver Off Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","44"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130049","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Silver","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS4914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130049-01","Standard Silver On Exchange Plan","70.20%","0.70112931728363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,700","$200","$1,500","$0","$1,100","$0","45"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130050","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130050-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","46"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130050","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130050-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","47"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130051","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130051-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","48"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130051","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130051-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$5,200","$0","$0","$0","49"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130052","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130052-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","50"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130052","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5214","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130052-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","51"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130053","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130053-00","Standard Bronze Off Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","52"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130053","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5314","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130053-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,300","$0","$0","$200","$5,200","$0","$0","$0","53"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130054","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130054-00","Standard Bronze Off Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","54"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130054","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5414","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130054-01","Standard Bronze On Exchange Plan","62.00%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","55"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130055","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130055-00","Standard Bronze Off Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","56"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130055","Vesta Select","50816IN013","7831192068","INN002","INS001","INF006","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5514","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130055-01","Standard Bronze On Exchange Plan","61.20%","0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$1,100","$200","$3,500","$0","$500","$0","57"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130056","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130056-00","Standard Bronze Off Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","58"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130056","Vesta Select","50816IN013","7831192068","INN002","INS001","INF005","New","HMO","Bronze","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS5614","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130056-01","Standard Bronze On Exchange Plan","61.60%","0.62048351764679","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$200","$4,000","$0","$200","$0","59"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130059","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP5914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130059-00","Standard Gold Off Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","60"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130059","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP5914","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130059-01","Standard Gold On Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","61"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130060","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS6014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130060-00","Standard Gold Off Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","62"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","6","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130060","Vesta Select","50816IN013","7831192068","INN002","INS001","INF003","New","HMO","Gold","Yes","Both","No","No",,"Pediatric Dental",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHS6014","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130060-01","Standard Gold On Exchange Plan","79.90%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,000","$0","$0","$0","63"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","7","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130061","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP6114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130061-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","4"
"2014","IN","50816","HIOS","9","2013-11-26 13:14:08","7","50816","IN","SHOP (Small Group)","No","31-1069321","50816IN0130061","Vesta Premier","50816IN013","7831192068","INN001","INS001","INF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.phpni.com/marketplace/shop/sbc?planid=QHP6114","https://secure.phpni.com/SecurePortals/marketplace/payment","http://www.phpni.com/marketplace/shopbrochure","http://www.phpni.com/Pharmacy/Pharmacy.aspx","50816IN0130061-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$0","5"
"2014","IN","56340","HIOS","2","2013-07-31 07:05:07","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010001","DentalConnect�","56340IN001",,"INN001","INS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"56340IN0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","56340","HIOS","2","2013-07-31 07:05:07","1","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010002","DentalConnect�","56340IN001",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"56340IN0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","56340","HIOS","2","2013-07-31 07:05:07","2","56340","IN","SHOP (Small Group)","Yes","35-0472300","56340IN0010003","DentalConnect�","56340IN001",,"INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"25.37",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"56340IN0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0010001","Guardian Pediatric Advantage","59560IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0010001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0010001","Guardian Pediatric Advantage","59560IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0010001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0020001","Guardian Pediatric Essentials","59560IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0020001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","1","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0020001","Guardian Pediatric Essentials","59560IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0020001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","2","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0030001","Guardian Family Advantage Plus","59560IN003",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0030001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010004","MDwise Marketplace Bronze","85320IN001",,"INN004","INS004","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010004-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","13"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010004","MDwise Marketplace Bronze","85320IN001",,"INN004","INS004","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","14"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010004","MDwise Marketplace Bronze","85320IN001",,"INN004","INS004","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010004-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","15"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010005","MDwise Marketplace Bronze","85320IN001",,"INN005","INS005","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010005-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","16"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010005","MDwise Marketplace Bronze","85320IN001",,"INN005","INS005","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","17"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010005","MDwise Marketplace Bronze","85320IN001",,"INN005","INS005","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010005-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","18"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010013","MDwise Marketplace Bronze","85320IN001",,"INN013","INS013","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","41"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010013","MDwise Marketplace Bronze","85320IN001",,"INN013","INS013","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010013-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","42"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010014","MDwise Marketplace Bronze","85320IN001",,"INN014","INS014","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010014-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","43"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010014","MDwise Marketplace Bronze","85320IN001",,"INN014","INS014","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","44"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010014","MDwise Marketplace Bronze","85320IN001",,"INN014","INS014","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010014-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","45"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010015","MDwise Marketplace Bronze","85320IN001",,"INN015","INS015","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010015-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","46"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010015","MDwise Marketplace Bronze","85320IN001",,"INN015","INS015","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","47"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010015","MDwise Marketplace Bronze","85320IN001",,"INN015","INS015","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010015-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","48"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010016","MDwise Marketplace Bronze","85320IN001",,"INN016","INS016","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010016-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","49"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010016","MDwise Marketplace Bronze","85320IN001",,"INN016","INS016","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","50"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010016","MDwise Marketplace Bronze","85320IN001",,"INN016","INS016","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010016-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","51"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010017","MDwise Marketplace Bronze","85320IN001",,"INN017","INS017","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010017-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","52"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010017","MDwise Marketplace Bronze","85320IN001",,"INN017","INS017","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","53"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010017","MDwise Marketplace Bronze","85320IN001",,"INN017","INS017","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010017-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","54"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","2","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0030001","Guardian Family Advantage Plus","59560IN003",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0030001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010018","MDwise Marketplace Bronze","85320IN001",,"INN018","INS018","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010018-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","55"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010018","MDwise Marketplace Bronze","85320IN001",,"INN018","INS018","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","56"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010018","MDwise Marketplace Bronze","85320IN001",,"INN018","INS018","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010018-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","57"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010019","MDwise Marketplace Bronze","85320IN001",,"INN019","INS019","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010019-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","58"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010019","MDwise Marketplace Bronze","85320IN001",,"INN019","INS019","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","59"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010019","MDwise Marketplace Bronze","85320IN001",,"INN019","INS019","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010019-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","60"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010020","MDwise Marketplace Bronze","85320IN001",,"INN020","INS020","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010020-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","61"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010020","MDwise Marketplace Bronze","85320IN001",,"INN020","INS020","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","62"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010020","MDwise Marketplace Bronze","85320IN001",,"INN020","INS020","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010020-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","63"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010021","MDwise Marketplace Bronze","85320IN001",,"INN021","INS021","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010021-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","64"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010021","MDwise Marketplace Bronze","85320IN001",,"INN021","INS021","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","65"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010021","MDwise Marketplace Bronze","85320IN001",,"INN021","INS021","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010021-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","66"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0050001","Guardian Family Essentials Plus","59560IN005",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0050001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","3","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0050001","Guardian Family Essentials Plus","59560IN005",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0050001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","4","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0040001","Guardian Family Advantage","59560IN004",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0040001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","Individual","Yes","95-6042390","83557IN0020006","BESTOne Dental Basic - Silver","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"83557IN0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010006","BEST Dental Basic - Silver","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Basic_Plan_(Silver).pdf",,"83557IN0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010006","BEST Dental Basic - Silver","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Basic_Plan_(Silver).pdf",,"83557IN0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","4","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0040001","Guardian Family Advantage","59560IN004",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0040001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010023","MDwise Marketplace Bronze","85320IN001",,"INN023","INS023","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","71"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","9"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","10"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","11"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","12"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","13"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","14"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010025","MDwise Marketplace Silver","85320IN001",,"INN002","INS002","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010025-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","15"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","16"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","17"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","18"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","19"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","20"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010026","MDwise Marketplace Silver","85320IN001",,"INN003","INS003","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010026-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","21"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010023","MDwise Marketplace Bronze","85320IN001",,"INN023","INS023","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010023-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","72"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","4"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","5"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","6"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","7"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010024","MDwise Marketplace Silver","85320IN001",,"INN001","INS001","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010024-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","8"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","4","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0060001","Guardian Family Essentials","59560IN006",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0060001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","59560","HIOS","4","2013-09-02 11:39:25","4","59560","IN","SHOP (Small Group)","Yes","13-5123390","59560IN0060001","Guardian Family Essentials","59560IN006",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"59560IN0060001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","69051","HIOS","2","2013-07-23 22:50:01","1","69051","IN","SHOP (Small Group)","Yes","13-5581829","69051IN0110001","EHB Basic Dental Plan (Low)","69051IN011","7326041556","INN001","INS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$15.56",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48421",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48420",,"69051IN0110001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","69051","HIOS","2","2013-07-23 22:50:01","2","69051","IN","SHOP (Small Group)","Yes","13-5581829","69051IN0120001","EHB Enhanced Dental Plan (High)","69051IN012","7326041556","INN002","INS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$19.99",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48421",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48420",,"69051IN0120001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","24"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","25"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","26"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","27"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","28"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","29"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","30"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","31"
"2014","IN","69051","HIOS","2","2013-07-23 22:50:01","3","69051","IN","SHOP (Small Group)","Yes","13-5581829","69051IN0130001","Family Basic Dental Plan (Low)","69051IN013","7326041556","INN003","INS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$15.56",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48421",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48420",,"69051IN0130001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","69051","HIOS","2","2013-07-23 22:50:01","4","69051","IN","SHOP (Small Group)","Yes","13-5581829","69051IN0140001","Family Enhanced Dental Plan (High)","69051IN014","7326041556","INN004","INS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.99",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48421",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48420",,"69051IN0140001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","1","83557","IN","Individual","Yes","95-6042390","83557IN0020001","BESTOne Child Dental Plus","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Child_Dental_Plus_Plan.pdf",,"83557IN0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010001","BEST Life Child Dental Plus","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Child_Dental_Plus_Plan.pdf",,"83557IN0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","1","83557","IN","Individual","Yes","95-6042390","83557IN0020001","BESTOne Child Dental Plus","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Child_Dental_Plus_Plan.pdf",,"83557IN0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","1","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010001","BEST Life Child Dental Plus","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Child_Dental_Plus_Plan.pdf",,"83557IN0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","2","83557","IN","Individual","Yes","95-6042390","83557IN0020002","BESTOne Child Dental","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Child_Dental_Plan.pdf",,"83557IN0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010002","BEST Life Child Dental","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Child_Dental_Plan.pdf",,"83557IN0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","2","83557","IN","Individual","Yes","95-6042390","83557IN0020002","BESTOne Child Dental","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Child_Dental_Plan.pdf",,"83557IN0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","2","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010002","BEST Life Child Dental","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Child_Dental_Plan.pdf",,"83557IN0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010003","BEST Dental Advantage - Gold","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Advantage_Plan_(Gold).pdf",,"83557IN0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","Individual","Yes","95-6042390","83557IN0020003","BESTOne Dental Advantage - Gold","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"83557IN0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010003","BEST Dental Advantage - Gold","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Advantage_Plan_(Gold).pdf",,"83557IN0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","Individual","Yes","95-6042390","83557IN0020003","BESTOne Dental Advantage - Gold","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"83557IN0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","Individual","Yes","95-6042390","83557IN0020004","BESTOne Dental Plus - Gold","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"83557IN0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010004","BEST Dental Plus - Gold","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Plus_Plan_(Gold).pdf",,"83557IN0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010004","BEST Dental Plus - Gold","83557IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Plus_Plan_(Gold).pdf",,"83557IN0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","3","83557","IN","Individual","Yes","95-6042390","83557IN0020004","BESTOne Dental Plus - Gold","83557IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"83557IN0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010005","BEST Dental Plus - Silver","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Plus_Plan_(Silver).pdf",,"83557IN0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","Individual","Yes","95-6042390","83557IN0020005","BESTOne Dental Plus - Silver","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"83557IN0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","SHOP (Small Group)","Yes","95-6042390","83557IN0010005","BEST Dental Plus - Silver","83557IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BEST_Dental_Plus_Plan_(Silver).pdf",,"83557IN0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","Individual","Yes","95-6042390","83557IN0020005","BESTOne Dental Plus - Silver","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"83557IN0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","83557","HIOS","8","2014-01-21 08:29:49","4","83557","IN","Individual","Yes","95-6042390","83557IN0020006","BESTOne Dental Basic - Silver","83557IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IN/pdf/IN_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"83557IN0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010001","MDwise Marketplace Bronze","85320IN001",,"INN001","INS001","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010001-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","4"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010001","MDwise Marketplace Bronze","85320IN001",,"INN001","INS001","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","5"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010001","MDwise Marketplace Bronze","85320IN001",,"INN001","INS001","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010001-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","6"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010002","MDwise Marketplace Bronze","85320IN001",,"INN002","INS002","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010002-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","7"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010002","MDwise Marketplace Bronze","85320IN001",,"INN002","INS002","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","8"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010002","MDwise Marketplace Bronze","85320IN001",,"INN002","INS002","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010002-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","9"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010003","MDwise Marketplace Bronze","85320IN001",,"INN003","INS003","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010003-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","10"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010003","MDwise Marketplace Bronze","85320IN001",,"INN003","INS003","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","11"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010003","MDwise Marketplace Bronze","85320IN001",,"INN003","INS003","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010003-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","12"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010007","MDwise Marketplace Bronze","85320IN001",,"INN007","INS007","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010007-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","22"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010007","MDwise Marketplace Bronze","85320IN001",,"INN007","INS007","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","23"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010007","MDwise Marketplace Bronze","85320IN001",,"INN007","INS007","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010007-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","24"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010008","MDwise Marketplace Bronze","85320IN001",,"INN008","INS008","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010008-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","25"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010008","MDwise Marketplace Bronze","85320IN001",,"INN008","INS008","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","26"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010008","MDwise Marketplace Bronze","85320IN001",,"INN008","INS008","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010008-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","27"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010009","MDwise Marketplace Bronze","85320IN001",,"INN009","INS009","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010009-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","28"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010009","MDwise Marketplace Bronze","85320IN001",,"INN009","INS009","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","29"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010009","MDwise Marketplace Bronze","85320IN001",,"INN009","INS009","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010009-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","30"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010010","MDwise Marketplace Bronze","85320IN001",,"INN010","INS010","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010010-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","31"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010010","MDwise Marketplace Bronze","85320IN001",,"INN010","INS010","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","32"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010010","MDwise Marketplace Bronze","85320IN001",,"INN010","INS010","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010010-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","33"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010011","MDwise Marketplace Bronze","85320IN001",,"INN011","INS011","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010011-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","34"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010011","MDwise Marketplace Bronze","85320IN001",,"INN011","INS011","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","35"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010011","MDwise Marketplace Bronze","85320IN001",,"INN011","INS011","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010011-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","36"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010012","MDwise Marketplace Bronze","85320IN001",,"INN012","INS012","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010012-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","37"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010012","MDwise Marketplace Bronze","85320IN001",,"INN012","INS012","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","38"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010012","MDwise Marketplace Bronze","85320IN001",,"INN012","INS012","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010012-03","Limited Cost Sharing Plan Variation",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","39"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010013","MDwise Marketplace Bronze","85320IN001",,"INN013","INS013","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010013-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","40"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","1","85320","IN","Individual","No","35-1931354","85320IN0010023","MDwise Marketplace Bronze","85320IN001",,"INN023","INS023","INF001","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/bronze","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010023-01","Standard Bronze On Exchange Plan",,"0.590464353561401","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","35%","$5,000","$10,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","3500","20","590","0","3500","570","190","0","70"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","22"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010027","MDwise Marketplace Silver","85320IN001",,"INN004","INS004","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","23"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","32"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010028","MDwise Marketplace Silver","85320IN001",,"INN005","INS005","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010028-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","33"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","40"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","41"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","42"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","43"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","44"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010030","MDwise Marketplace Silver","85320IN001",,"INN007","INS007","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010030-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","45"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","46"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","47"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","48"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","49"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","50"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010031","MDwise Marketplace Silver","85320IN001",,"INN008","INS008","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010031-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","51"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","52"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","53"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","54"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","55"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","56"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010032","MDwise Marketplace Silver","85320IN001",,"INN009","INS009","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010032-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","57"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","58"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","59"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","60"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","61"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","62"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010033","MDwise Marketplace Silver","85320IN001",,"INN010","INS010","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010033-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","63"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","64"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","65"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","66"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","67"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","68"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010034","MDwise Marketplace Silver","85320IN001",,"INN011","INS011","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010034-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","69"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","70"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","71"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","72"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","73"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","74"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010035","MDwise Marketplace Silver","85320IN001",,"INN012","INS012","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010035-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","75"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","76"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","77"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","78"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","79"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","80"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010036","MDwise Marketplace Silver","85320IN001",,"INN013","INS013","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010036-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","81"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","82"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","83"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","84"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","85"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","86"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010037","MDwise Marketplace Silver","85320IN001",,"INN014","INS014","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010037-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","87"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","88"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","89"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","90"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","91"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","92"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010038","MDwise Marketplace Silver","85320IN001",,"INN015","INS015","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010038-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","93"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","94"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","95"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","96"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","97"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","98"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010039","MDwise Marketplace Silver","85320IN001",,"INN016","INS016","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010039-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","99"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","100"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","101"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","102"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","103"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","104"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010040","MDwise Marketplace Silver","85320IN001",,"INN017","INS017","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010040-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","105"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","106"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","107"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","108"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","109"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","110"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010041","MDwise Marketplace Silver","85320IN001",,"INN018","INS018","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010041-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","111"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","112"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","113"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","114"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","115"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","116"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010042","MDwise Marketplace Silver","85320IN001",,"INN019","INS019","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010042-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","117"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","118"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","119"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","120"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","121"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","122"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010043","MDwise Marketplace Silver","85320IN001",,"INN020","INS020","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010043-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","123"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","124"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","125"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","126"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","127"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","128"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010044","MDwise Marketplace Silver","85320IN001",,"INN021","INS021","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010044-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","129"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-01","Standard Silver On Exchange Plan",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","136"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","137"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-03","Limited Cost Sharing Plan Variation",,"0.681459486484528","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","15%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1500","20","550","0","1500","640","150","0","138"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-04","73% AV Level Silver Plan",,"0.73688280582428","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,000","$10,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","10%","$3,500","$10,500","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","1250","20","390","0","1250","660","100","0","139"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-05","87% AV Level Silver Plan",,"0.875592470169067","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,250","$2,500","$2,200","$4,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","5%","$1,500","$4,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","250","210","220","0","250","590","50","0","140"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","2","85320","IN","Individual","No","35-1931354","85320IN0010046","MDwise Marketplace Silver","85320IN001",,"INN023","INS023","INF002","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","MDwise.org/marketplace/benefits/silver","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010046-06","94% AV Level Silver Plan",,"0.943656146526337","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%","$500","$1,500","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","280","220","0","0","380","60","0","141"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010047","MDwise Marketplace Gold","85320IN001",,"INN001","INS001","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010047-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","4"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010047","MDwise Marketplace Gold","85320IN001",,"INN001","INS001","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010047-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","5"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010047","MDwise Marketplace Gold","85320IN001",,"INN001","INS001","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010047-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","6"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010048","MDwise Marketplace Gold","85320IN001",,"INN002","INS002","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010048-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","7"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010048","MDwise Marketplace Gold","85320IN001",,"INN002","INS002","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010048-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","8"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010048","MDwise Marketplace Gold","85320IN001",,"INN002","INS002","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010048-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","9"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010049","MDwise Marketplace Gold","85320IN001",,"INN003","INS003","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010049-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","10"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010049","MDwise Marketplace Gold","85320IN001",,"INN003","INS003","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010049-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","11"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010049","MDwise Marketplace Gold","85320IN001",,"INN003","INS003","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010049-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","12"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010050","MDwise Marketplace Gold","85320IN001",,"INN004","INS004","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010050-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","13"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010050","MDwise Marketplace Gold","85320IN001",,"INN004","INS004","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010050-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","14"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010050","MDwise Marketplace Gold","85320IN001",,"INN004","INS004","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010050-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","15"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010051","MDwise Marketplace Gold","85320IN001",,"INN005","INS005","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010051-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","16"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010051","MDwise Marketplace Gold","85320IN001",,"INN005","INS005","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","17"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010051","MDwise Marketplace Gold","85320IN001",,"INN005","INS005","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010051-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","18"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010053","MDwise Marketplace Gold","85320IN001",,"INN007","INS007","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010053-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","22"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010053","MDwise Marketplace Gold","85320IN001",,"INN007","INS007","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010053-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","23"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010053","MDwise Marketplace Gold","85320IN001",,"INN007","INS007","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010053-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","24"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010054","MDwise Marketplace Gold","85320IN001",,"INN008","INS008","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010054-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","25"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010054","MDwise Marketplace Gold","85320IN001",,"INN008","INS008","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010054-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","26"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010054","MDwise Marketplace Gold","85320IN001",,"INN008","INS008","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010054-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","27"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010055","MDwise Marketplace Gold","85320IN001",,"INN009","INS009","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010055-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","28"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010055","MDwise Marketplace Gold","85320IN001",,"INN009","INS009","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010055-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","29"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010055","MDwise Marketplace Gold","85320IN001",,"INN009","INS009","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010055-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","30"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010056","MDwise Marketplace Gold","85320IN001",,"INN010","INS010","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010056-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","31"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010056","MDwise Marketplace Gold","85320IN001",,"INN010","INS010","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010056-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","32"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010056","MDwise Marketplace Gold","85320IN001",,"INN010","INS010","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010056-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","33"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010057","MDwise Marketplace Gold","85320IN001",,"INN011","INS011","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010057-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","34"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010057","MDwise Marketplace Gold","85320IN001",,"INN011","INS011","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010057-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","35"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010057","MDwise Marketplace Gold","85320IN001",,"INN011","INS011","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010057-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","36"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010058","MDwise Marketplace Gold","85320IN001",,"INN012","INS012","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010058-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","37"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010058","MDwise Marketplace Gold","85320IN001",,"INN012","INS012","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","38"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010058","MDwise Marketplace Gold","85320IN001",,"INN012","INS012","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010058-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","39"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010059","MDwise Marketplace Gold","85320IN001",,"INN013","INS013","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010059-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","40"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010059","MDwise Marketplace Gold","85320IN001",,"INN013","INS013","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","41"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010059","MDwise Marketplace Gold","85320IN001",,"INN013","INS013","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010059-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","42"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010060","MDwise Marketplace Gold","85320IN001",,"INN014","INS014","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010060-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","43"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010060","MDwise Marketplace Gold","85320IN001",,"INN014","INS014","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010060-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","44"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010060","MDwise Marketplace Gold","85320IN001",,"INN014","INS014","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010060-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","45"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010061","MDwise Marketplace Gold","85320IN001",,"INN015","INS015","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010061-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","46"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010061","MDwise Marketplace Gold","85320IN001",,"INN015","INS015","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010061-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","47"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010061","MDwise Marketplace Gold","85320IN001",,"INN015","INS015","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010061-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","48"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010062","MDwise Marketplace Gold","85320IN001",,"INN016","INS016","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010062-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","49"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010062","MDwise Marketplace Gold","85320IN001",,"INN016","INS016","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","50"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010062","MDwise Marketplace Gold","85320IN001",,"INN016","INS016","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010062-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","51"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010063","MDwise Marketplace Gold","85320IN001",,"INN017","INS017","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010063-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","52"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010063","MDwise Marketplace Gold","85320IN001",,"INN017","INS017","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","53"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010063","MDwise Marketplace Gold","85320IN001",,"INN017","INS017","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010063-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","54"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010064","MDwise Marketplace Gold","85320IN001",,"INN018","INS018","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010064-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","55"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010064","MDwise Marketplace Gold","85320IN001",,"INN018","INS018","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","56"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010064","MDwise Marketplace Gold","85320IN001",,"INN018","INS018","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010064-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","57"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010065","MDwise Marketplace Gold","85320IN001",,"INN019","INS019","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010065-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","58"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010065","MDwise Marketplace Gold","85320IN001",,"INN019","INS019","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","59"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010065","MDwise Marketplace Gold","85320IN001",,"INN019","INS019","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010065-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","60"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010066","MDwise Marketplace Gold","85320IN001",,"INN020","INS020","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010066-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","61"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010066","MDwise Marketplace Gold","85320IN001",,"INN020","INS020","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010066-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","62"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010066","MDwise Marketplace Gold","85320IN001",,"INN020","INS020","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010066-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","63"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010067","MDwise Marketplace Gold","85320IN001",,"INN021","INS021","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010067-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","64"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010067","MDwise Marketplace Gold","85320IN001",,"INN021","INS021","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010067-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","65"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010067","MDwise Marketplace Gold","85320IN001",,"INN021","INS021","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits/gold","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010067-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","66"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010069","MDwise Marketplace Gold","85320IN001",,"INN023","INS023","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010069-01","Standard Gold On Exchange Plan",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","70"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010069","MDwise Marketplace Gold","85320IN001",,"INN023","INS023","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","71"
"2014","IN","85320","HIOS","7","2014-01-21 08:29:49","3","85320","IN","Individual","No","35-1931354","85320IN0010069","MDwise Marketplace Gold","85320IN001",,"INN023","INS023","INF003","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","mdwise.org/marketplace/benefits","https://mdwise.softheon.com/payment","mdwise.org/marketplace","mdwise.org/marketplace/pharmacy","85320IN0010069-03","Limited Cost Sharing Plan Variation",,"0.781238555908203","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$2,100","10%","$2,000","$6,000","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","700","20","450","0","700","550","100","0","72"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020001",,"91920IN0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","Individual","Yes","75-1233841","91920IN0010001","Dentegra Dental PPO Children's Plan 70","91920IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010001",,"91920IN0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","Individual","Yes","75-1233841","91920IN0010001","Dentegra Dental PPO Children's Plan 70","91920IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010001",,"91920IN0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020001",,"91920IN0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","Individual","Yes","75-1233841","91920IN0010002","Dentegra Dental PPO Children's Plan 85","91920IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010002",,"91920IN0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020002",,"91920IN0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020002",,"91920IN0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","1","91920","IN","Individual","Yes","75-1233841","91920IN0010002","Dentegra Dental PPO Children's Plan 85","91920IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010002",,"91920IN0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","2","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020006",,"91920IN0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","2","91920","IN","Individual","Yes","75-1233841","91920IN0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","91920IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010006",,"91920IN0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","2","91920","IN","Individual","Yes","75-1233841","91920IN0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","91920IN001",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010006",,"91920IN0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","2","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020006",,"91920IN0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","3","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020004",,"91920IN0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","3","91920","IN","Individual","Yes","75-1233841","91920IN0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","91920IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010004",,"91920IN0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","3","91920","IN","SHOP (Small Group)","Yes","75-1233841","91920IN0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","91920IN002",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/in/91920in0020004",,"91920IN0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IN","91920","HIOS","6","2014-01-17 09:36:20","3","91920","IN","Individual","Yes","75-1233841","91920IN0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","91920IN001",,"INN001","INS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/in/91920in0010004",,"91920IN0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","1","18575","LA","Individual","Yes","72-0977315","18575LA0010001","AlwaysCare AllStar Kids Dental Plan","18575LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0010001-00","Standard High Off Exchange Plan","83.04%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-03","Limited Cost Sharing Plan Variation","70.60%","0.697980642318726","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","18"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","1","18575","LA","Individual","Yes","72-0977315","18575LA0010002","AlwaysCare AllStar Kids Dental Plan","18575LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0010002-00","Standard Low Off Exchange Plan","71.24%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-00","Standard Silver Off Exchange Plan","71.40%","0.706590473651886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","40%",,,,"$4,000","$12,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","8"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-01","Standard Silver On Exchange Plan","71.40%","0.706590473651886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","40%",,,,"$4,000","$12,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","9"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","2","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010006",,"18802LA0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","3","18802","LA","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","18802LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010004",,"18802LA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","3","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010004",,"18802LA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250001","Blue POS copay 80/60 $500A","19636LA025","7598768720","LAN005","LAS007","LAF001","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250001-00","Standard Gold Off Exchange Plan","80.60%","0.800082266330719","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$60","$794","$150","$500","$850","$154","$79","4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220008","Blue POS 70/50 $3500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220008-00","Standard Bronze Off Exchange Plan",,"0.605709373950958","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500","30%",,,,"$7,000","$21,000","$10,500","$31,500","$3,500","$0","$1,134","$150","$3,500","$0","$531","$79","4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","5","44965","LA","Individual","No","72-1279235","44965LA0580003","Humana National Preferred Bronze 4850/6350 Plan","44965LA058",,"LAN002","LAS002","LAF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104557","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058953","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010001","LAHC Platinum Plus","67202LA001",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010001-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030001","LAHC Platinum Plus","67202LA003",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030001-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010001","LAHC Platinum Plus","67202LA001",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010001-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030001","LAHC Platinum Plus","67202LA003",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030001-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010001","LAHC Platinum Plus","67202LA001",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030002","LAHC Gold Plus","67202LA003",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030002-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010001","LAHC Platinum Plus","67202LA001",,"LAN005","LAS005","LAF001","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_PlatinumPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010001-03","Limited Cost Sharing Plan Variation",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Connect Gold 2500/3500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104505","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058862","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570004-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Connect Gold 2500/3500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104505","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058862","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Connect Gold 2500/3500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104505","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058862","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250001","Blue POS copay 80/60 $500A","19636LA025","7598768720","LAN005","LAS007","LAF001","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250001-01","Standard Gold On Exchange Plan","80.60%","0.800082266330719","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$60","$794","$150","$500","$850","$154","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220008","Blue POS 70/50 $3500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220008-01","Standard Bronze On Exchange Plan",,"0.605709373950958","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500","30%",,,,"$7,000","$21,000","$10,500","$31,500","$3,500","$0","$1,134","$150","$3,500","$0","$531","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220009","Blue POS 70/50 $4500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220009-00","Standard Bronze Off Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","8"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220009","Blue POS 70/50 $4500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220009-01","Standard Bronze On Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","9"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220009","Blue POS 70/50 $4500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220009","Blue POS 70/50 $4500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220009-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220009-03","Limited Cost Sharing Plan Variation",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","11"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0230004","Community Blue POS 70/50 $4500","19636LA023","7598768720","LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0230004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0230004","Community Blue POS 70/50 $4500","19636LA023","7598768720","LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0230004-03","Limited Cost Sharing Plan Variation",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","15"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0240004","Blue Connect POS 70/50 $4500","19636LA024","7598768720","LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0240004-00","Standard Bronze Off Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","16"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0240004","Blue Connect POS 70/50 $4500","19636LA024","7598768720","LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0240004-01","Standard Bronze On Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","17"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","1","18575","LA","Individual","Yes","72-0977315","18575LA0010001","AlwaysCare AllStar Kids Dental Plan","18575LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0010001-01","Standard High On Exchange Plan","83.04%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0230004","Community Blue POS 70/50 $4500","19636LA023","7598768720","LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0230004-00","Standard Bronze Off Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","12"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0230004","Community Blue POS 70/50 $4500","19636LA023","7598768720","LAN007","LAS006","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0230004-01","Standard Bronze On Exchange Plan",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","13"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-05","87% AV Level Silver Plan","86.50%","0.860587000846863","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$750","$2,250","5%",,,,"$6,000","$18,000","$6,750","$20,250","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$773","$35","$186","$150","$1,250","$395","$157","$79","42"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-06","94% AV Level Silver Plan","93.70%","0.937551975250244","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$0","$0","0%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$23","$35","$0","$150","$500","$395","$382","$79","43"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-05","87% AV Level Silver Plan","86.33%","0.863307356834412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-06","94% AV Level Silver Plan","93.72%","0.937241017818451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580006","Humana National Preferred Gold 2500/3500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104596","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059031","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580006-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580006","Humana National Preferred Gold 2500/3500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104596","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059031","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580006-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-06","94% AV Level Silver Plan",,"0.935929656028748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040004","LAHC Bronze","67202LA004",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040004-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-00","Standard Silver Off Exchange Plan","70.60%","0.697980642318726","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","15"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-01","Standard Silver On Exchange Plan","70.60%","0.697980642318726","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","16"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-04","73% AV Level Silver Plan","72.80%","0.736639440059662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","19"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-05","87% AV Level Silver Plan","86.70%","0.862076938152313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$750","$2,250","5%",,,,"$6,000","$18,000","$6,750","$20,250","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$773","$35","$186","$150","$1,250","$395","$157","$79","20"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-06","94% AV Level Silver Plan","93.90%","0.939292848110199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$0","$0","0%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$23","$35","$0","$150","$500","$395","$382","$79","21"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue POS copay 80/60","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230002-00","Standard Gold Off Exchange Plan","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","22"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue POS copay 80/60","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230002-01","Standard Gold On Exchange Plan","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","23"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue POS copay 80/60","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","24"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230002","Community Blue POS copay 80/60","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230002-03","Limited Cost Sharing Plan Variation","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","25"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-00","Standard Silver Off Exchange Plan","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","26"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-01","Standard Silver On Exchange Plan","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","27"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","28"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-03","Limited Cost Sharing Plan Variation","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","29"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-04","73% AV Level Silver Plan","72.70%","0.735635995864868","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","$17,500","$35,000","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","30"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220007","Blue POS copay 70/50 $3000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","1","18575","LA","Individual","Yes","72-0977315","18575LA0010002","AlwaysCare AllStar Kids Dental Plan","18575LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0010002-01","Standard Low On Exchange Plan","71.24%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","2","18575","LA","Individual","Yes","72-0977315","18575LA0020001","AlwaysCare AllStar Family Dental Plan","18575LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$44.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0020001-00","Standard High Off Exchange Plan","83.04%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","2","18575","LA","Individual","Yes","72-0977315","18575LA0020001","AlwaysCare AllStar Family Dental Plan","18575LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$44.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0020001-01","Standard High On Exchange Plan","83.04%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","2","18575","LA","Individual","Yes","72-0977315","18575LA0020002","AlwaysCare AllStar Family Dental Plan","18575LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0020002-00","Standard Low Off Exchange Plan","71.24%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","18575","HIOS","4","2014-01-21 08:29:49","2","18575","LA","Individual","Yes","72-0977315","18575LA0020002","AlwaysCare AllStar Family Dental Plan","18575LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"18575LA0020002-01","Standard Low On Exchange Plan","71.24%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","Individual","Yes","94-2761537","18802LA0010001","Delta Dental PPO Plan 70 for Children","18802LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010001",,"18802LA0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010001",,"18802LA0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010001",,"18802LA0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","Individual","Yes","94-2761537","18802LA0010001","Delta Dental PPO Plan 70 for Children","18802LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010001",,"18802LA0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010002",,"18802LA0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","Individual","Yes","94-2761537","18802LA0010002","Delta Dental PPO Plan 85 for Children","18802LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010002",,"18802LA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","Individual","Yes","94-2761537","18802LA0010002","Delta Dental PPO Plan 85 for Children","18802LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010002",,"18802LA0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","1","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010002",,"18802LA0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","2","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010006",,"18802LA0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","2","18802","LA","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","18802LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010006",,"18802LA0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","2","18802","LA","Individual","Yes","94-2761537","18802LA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","18802LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010006",,"18802LA0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","3","18802","LA","Individual","Yes","94-2761537","18802LA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","18802LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010004",,"18802LA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","18802","HIOS","8","2014-01-21 08:29:49","3","18802","LA","SHOP (Small Group)","Yes","94-2761537","18802LA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","18802LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/la/18802la0010004",,"18802LA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250002","Blue POS copay 80/60 $1000A","19636LA025","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250002-00","Standard Gold Off Exchange Plan","79.70%","0.789866328239441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220008","Blue POS 70/50 $3500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0220008","Blue POS 70/50 $3500","19636LA022","7598768720","LAN005","LAS007","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0220008-03","Limited Cost Sharing Plan Variation",,"0.605709373950958","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$10,500","30%",,,,"$7,000","$21,000","$10,500","$31,500","$3,500","$0","$1,134","$150","$3,500","$0","$531","$79","7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250002","Blue POS copay 80/60 $1000A","19636LA025","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250002-01","Standard Gold On Exchange Plan","79.70%","0.789866328239441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0240004","Blue Connect POS 70/50 $4500","19636LA024","7598768720","LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0240004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","18"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","1","19636","LA","Individual","No","72-1071369","19636LA0240004","Blue Connect POS 70/50 $4500","19636LA024","7598768720","LAN006","LAS005","LAF003","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-2tier-formulary","19636LA0240004-03","Limited Cost Sharing Plan Variation",,"0.588353335857391","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$12,700","30%",,,,"$9,000","$25,400","$13,500","$38,100","$4,500","$0","$834","$150","$4,500","$0","$231","$79","19"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 50/50 $2000","19636LA025","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250003-00","Standard Silver Off Exchange Plan","71.10%","0.704034030437469","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","50%",,,,"$4,000","$12,000","$6,000","$16,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$2,023","$55","$1,236","$150","$1,522","$985","$0","$79","4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220003","Blue POS copay 80/60 $500","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220003-00","Standard Gold Off Exchange Plan","81.10%","0.802798092365265","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$67","$794","$150","$500","$630","$154","$79","4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0230001","Community Blue POS copay 100/70","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0230001","Community Blue POS copay 100/70","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230001-03","Limited Cost Sharing Plan Variation","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","15"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0240001","Blue Connect POS copay 100/70","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240001-00","Standard Platinum Off Exchange Plan","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","$5,000","$15,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","16"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0240001","Blue Connect POS copay 100/70","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240001-01","Standard Platinum On Exchange Plan","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","17"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220003","Blue POS copay 80/60 $500","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220003-01","Standard Gold On Exchange Plan","81.10%","0.802798092365265","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$67","$794","$150","$500","$630","$154","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","SHOP (Small Group)","No","72-1071369","19636LA0250003","Blue POS copay 50/50 $2000","19636LA025","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0250003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0250003-01","Standard Silver On Exchange Plan","71.10%","0.704034030437469","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","50%",,,,"$4,000","$12,000","$6,000","$16,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$2,023","$55","$1,236","$150","$1,522","$985","$0","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220003","Blue POS copay 80/60 $500","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220003","Blue POS copay 80/60 $500","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220003-03","Limited Cost Sharing Plan Variation","81.10%","0.802798092365265","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$67","$794","$150","$500","$630","$154","$79","7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220004","Blue POS copay 80/60 $750","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220004-00","Standard Gold Off Exchange Plan","80.00%","0.792409420013428","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$67","$744","$150","$750","$630","$104","$79","8"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220004","Blue POS copay 80/60 $750","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220004-01","Standard Gold On Exchange Plan","80.00%","0.792409420013428","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$67","$744","$150","$750","$630","$104","$79","9"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220004","Blue POS copay 80/60 $750","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","2","19636","LA","Individual","No","72-1071369","19636LA0220004","Blue POS copay 80/60 $750","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220004-03","Limited Cost Sharing Plan Variation","80.00%","0.792409420013428","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$67","$744","$150","$750","$630","$104","$79","11"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","2","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020006",,"42544LA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","2","42544","LA","Individual","Yes","75-1233841","42544LA0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","42544LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020006",,"42544LA0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","2","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020006",,"42544LA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","3","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020004",,"42544LA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","3","42544","LA","Individual","Yes","75-1233841","42544LA0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","42544LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020004",,"42544LA0010004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","3","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020004",,"42544LA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","3","42544","LA","Individual","Yes","75-1233841","42544LA0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","42544LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020004",,"42544LA0010004-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0230001","Community Blue POS copay 100/70","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230001-00","Standard Platinum Off Exchange Plan","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","$5,000","$15,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","12"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0230001","Community Blue POS copay 100/70","19636LA023","7598768720","LAN007","LAS006","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230001-01","Standard Platinum On Exchange Plan","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","13"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0240001","Blue Connect POS copay 100/70","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","18"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0240001","Blue Connect POS copay 100/70","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240001-03","Limited Cost Sharing Plan Variation","88.40%","0.88389128446579","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","$12,000","$24,000","$0","$0","0%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","19"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-05","87% AV Level Silver Plan","86.65%","0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-06","94% AV Level Silver Plan","93.58%","0.935785233974457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$475","$950",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$475","$950","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","5","44965","LA","Individual","No","72-1279235","44965LA0580003","Humana National Preferred Bronze 4850/6350 Plan","44965LA058",,"LAN002","LAS002","LAF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104557","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058953","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220005-00","Standard Gold Off Exchange Plan","78.70%","0.778812348842621","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220005-01","Standard Gold On Exchange Plan","78.70%","0.778812348842621","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220005","Blue POS copay 80/60 $1000","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220005-03","Limited Cost Sharing Plan Variation","78.70%","0.778812348842621","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-03","Limited Cost Sharing Plan Variation","71.40%","0.706590473651886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","40%",,,,"$4,000","$12,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","11"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-04","73% AV Level Silver Plan","73.70%","0.72971111536026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,800","$25,600","$17,600","$36,200","$2,000","$6,000","40%",,,,"$4,000","$12,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$2,023","$60","$989","$150","$1,772","$924","$0","$79","12"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-05","87% AV Level Silver Plan","87.10%","0.867594659328461","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$750","$2,250","5%",,,,"$4,000","$12,000","$4,750","$14,250","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$773","$30","$186","$150","$1,250","$345","$209","$79","13"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0220006","Blue POS copay 60/40 $2000","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220006-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220006-06","94% AV Level Silver Plan","94.50%","0.94514274597168","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$0","$0","0%",,,,"$4,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","10%",,,,"$500","$1,500","$1,000","$1,500",,,,,,,,,,,"$23","$30","$0","$150","$500","$345","$509","$79","14"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-05","87% AV Level Silver Plan","86.50%","0.860587000846863","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$750","$2,250","5%",,,,"$6,000","$18,000","$6,750","$20,250","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$773","$35","$186","$150","$1,250","$395","$157","$79","31"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040002","LAHC Gold","67202LA004",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040002-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040002","LAHC Gold","67202LA004",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040002-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-03","Limited Cost Sharing Plan Variation",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040003","LAHC Silver","67202LA004",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040003-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-04","73% AV Level Silver Plan",,"0.723531305789948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-05","87% AV Level Silver Plan",,"0.863806486129761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040003","LAHC Silver","67202LA004",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040003-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040004","LAHC Bronze","67202LA004",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040004-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010004","LAHC Bronze Plus","67202LA001",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010004-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010004","LAHC Bronze Plus","67202LA001",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010004-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040005","LAHC Platinum","67202LA004",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040005-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010004","LAHC Bronze Plus","67202LA001",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0230003","Community Blue POS copay 70/50 $3000","19636LA023","7598768720","LAN007","LAS006","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0230003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-community-blue","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0230003-06","94% AV Level Silver Plan","93.70%","0.937551975250244","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$0","$0","0%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$23","$35","$0","$150","$500","$395","$382","$79","32"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","Yes","72-1279235","44965LA0590001","Humana Dental Smart Choice","44965LA059",,"LAN003","LAS003",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.99",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084472",,"44965LA0590001-01","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-03","Limited Cost Sharing Plan Variation","68.04%","0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-04","73% AV Level Silver Plan","72.18%","0.721818149089813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040010","LAHC Gold","67202LA004",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040010-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020002","LAHC Gold","67202LA002",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020002-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040010","LAHC Gold","67202LA004",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040010-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020002","LAHC Gold","67202LA002",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"31"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020002","LAHC Gold","67202LA002",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020002-03","Limited Cost Sharing Plan Variation",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040011","LAHC Silver","67202LA004",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040011-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040011","LAHC Silver","67202LA004",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040011-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040012","LAHC Bronze","67202LA004",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040012-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570003","Humana Connect Silver 4600/6300 Plan","44965LA057",,"LAN001","LAS001","LAF002","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104479","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058836","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect POS copay 80/60 $1000","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240002-00","Standard Gold Off Exchange Plan","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","33"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect POS copay 80/60 $1000","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240002-01","Standard Gold On Exchange Plan","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","34"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect POS copay 80/60 $1000","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","35"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240002","Blue Connect POS copay 80/60 $1000","19636LA024","7598768720","LAN006","LAS005","LAF002","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240002-03","Limited Cost Sharing Plan Variation","78.60%","0.77738881111145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,000","$3,000","20%",,,,"$5,000","$15,000","$6,000","$18,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,023","$60","$694","$150","$1,500","$645","$54","$79","36"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-00","Standard Silver Off Exchange Plan","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","37"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-01","Standard Silver On Exchange Plan","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","38"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","39"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-03","Limited Cost Sharing Plan Variation","70.50%","0.696720123291016","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","40"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","3","19636","LA","Individual","No","72-1071369","19636LA0240003","Blue Connect POS copay 70/50 $3000","19636LA024","7598768720","LAN006","LAS005","LAF001","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0240003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-blue-connect","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0240003-04","73% AV Level Silver Plan","72.70%","0.735635995864868","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,800","$25,600","$17,600","$35,200","$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$3,023","$60","$441","$150","$1,772","$924","$0","$79","41"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220001","Blue POS copay 100/70A","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220001-00","Standard Platinum Off Exchange Plan","89.50%","0.895074307918549","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$565","$0","$150","$0","$850","$254","$79","4"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220001","Blue POS copay 100/70A","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220001-01","Standard Platinum On Exchange Plan","89.50%","0.895074307918549","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$565","$0","$150","$0","$850","$254","$79","5"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220001","Blue POS copay 100/70A","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220001","Blue POS copay 100/70A","19636LA022","7598768720","LAN005","LAS007","LAF001","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220001-03","Limited Cost Sharing Plan Variation","89.50%","0.895074307918549","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$565","$0","$150","$0","$850","$254","$79","7"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220002","Blue POS copay 100/70B","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220002-00","Standard Platinum Off Exchange Plan","88.60%","0.885632157325745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","8"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220002","Blue POS copay 100/70B","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220002-01","Standard Platinum On Exchange Plan","88.60%","0.885632157325745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","9"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220002","Blue POS copay 100/70B","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","19636","HIOS","8","2014-01-21 08:29:49","4","19636","LA","Individual","No","72-1071369","19636LA0220002","Blue POS copay 100/70B","19636LA022","7598768720","LAN005","LAS007","LAF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","3","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=19636LA0220002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","19636LA0220002-03","Limited Cost Sharing Plan Variation","88.60%","0.885632157325745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$1,067","$0","$150","$0","$630","$254","$79","11"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","Individual","Yes","75-1233841","42544LA0010001","Dentegra Dental PPO Children's Plan 70","42544LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020001",,"42544LA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020001",,"42544LA0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020001",,"42544LA0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","Individual","Yes","75-1233841","42544LA0010001","Dentegra Dental PPO Children's Plan 70","42544LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020001",,"42544LA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","Individual","Yes","75-1233841","42544LA0010002","Dentegra Dental PPO Children's Plan 85","42544LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020002",,"42544LA0010002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020002",,"42544LA0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","Individual","Yes","75-1233841","42544LA0010002","Dentegra Dental PPO Children's Plan 85","42544LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020002",,"42544LA0010002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","1","42544","LA","SHOP (Small Group)","Yes","75-1233841","42544LA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","42544LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.03",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020002",,"42544LA0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","42544","HIOS","5","2014-01-17 09:36:20","2","42544","LA","Individual","Yes","75-1233841","42544LA0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","42544LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/la/42544la0020006",,"42544LA0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570004","Humana Connect Gold 2500/3500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104505","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058862","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Connect Platinum 1000/1500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104518","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058888","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570005-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030003","LAHC Silver Plus","67202LA003",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030003-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010002","LAHC Gold Plus","67202LA001",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010002-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010002","LAHC Gold Plus","67202LA001",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010002-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030003","LAHC Silver Plus","67202LA003",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030003-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010002","LAHC Gold Plus","67202LA001",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030004","LAHC Bronze Plus","67202LA003",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030004-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010002","LAHC Gold Plus","67202LA001",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010002-03","Limited Cost Sharing Plan Variation",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030004","LAHC Bronze Plus","67202LA003",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030004-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010003","LAHC Silver Plus","67202LA001",,"LAN005","LAS005","LAF003","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_SilverPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010003-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040001","LAHC Platinum","67202LA004",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040001-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040001","LAHC Platinum","67202LA004",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040001-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040005","LAHC Platinum","67202LA004",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040005-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Connect Platinum 1000/1500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104518","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058888","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Connect Platinum 1000/1500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104518","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058888","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","1","44965","LA","Individual","No","72-1279235","44965LA0570005","Humana Connect Platinum 1000/1500 Plan","44965LA057",,"LAN001","LAS001","LAF003","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104518","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058888","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0570005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570001","Humana Connect Basic 6350/6350 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104453","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058797","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570001","Humana Connect Basic 6350/6350 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104453","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058797","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Connect Bronze 6300/6300 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104466","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058810","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Connect Bronze 6300/6300 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104466","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058810","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Connect Bronze 6300/6300 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104466","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058810","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","2","44965","LA","Individual","No","72-1279235","44965LA0570002","Humana Connect Bronze 6300/6300 Plan","44965LA057",,"LAN001","LAS001","LAF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104466","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058810","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0570002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-00","Standard Silver Off Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-01","Standard Silver On Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-03","Limited Cost Sharing Plan Variation","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580004","Humana National Preferred Silver 4250/6250 Plan","44965LA058",,"LAN002","LAS002","LAF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104570","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058979","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580004-04","73% AV Level Silver Plan","72.51%","0.725123465061188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580006","Humana National Preferred Gold 2500/3500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104596","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059031","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580006","Humana National Preferred Gold 2500/3500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104596","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059031","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580006-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580007","Humana National Preferred Platinum 1000/1500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104609","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059057","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580007-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580007","Humana National Preferred Platinum 1000/1500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104609","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059057","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580007-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580007","Humana National Preferred Platinum 1000/1500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104609","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059057","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","3","44965","LA","Individual","No","72-1279235","44965LA0580007","Humana National Preferred Platinum 1000/1500 Plan","44965LA058",,"LAN002","LAS002","LAF007","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104609","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059057","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580007-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580001","Humana National Preferred Basic 6350/6350 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104531","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058914","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580001","Humana National Preferred Basic 6350/6350 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104531","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058914","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580002","Humana National Preferred Bronze 6300/6300 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104544","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058927","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580002","Humana National Preferred Bronze 6300/6300 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104544","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058927","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580002","Humana National Preferred Bronze 6300/6300 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104544","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058927","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580002","Humana National Preferred Bronze 6300/6300 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any covered expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104544","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058927","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-00","Standard Silver Off Exchange Plan","68.04%","0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","4","44965","LA","Individual","No","72-1279235","44965LA0580005","Humana National Preferred Silver 3650/3650 Plan","44965LA058",,"LAN002","LAS002","LAF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104583","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058992","http://apps.humana.com/marketing/documents.asp?file=2067338","44965LA0580005-01","Standard Silver On Exchange Plan","68.04%","0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","5","44965","LA","Individual","No","72-1279235","44965LA0580003","Humana National Preferred Bronze 4850/6350 Plan","44965LA058",,"LAN002","LAS002","LAF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104557","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058953","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","LA","44965","HIOS","8","2014-01-21 08:29:49","5","44965","LA","Individual","No","72-1279235","44965LA0580003","Humana National Preferred Bronze 4850/6350 Plan","44965LA058",,"LAN002","LAS002","LAF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9988",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104557","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058953","http://apps.humana.com/marketing/documents.asp?file=2067403","44965LA0580003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0030002","LAHC Gold Plus","67202LA003",,"LAN005","LAS005","LAF002","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_GoldPlus_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_group.pdf","http://www.mylahc.org/formulary","67202LA0030002-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,500","$17,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010004","LAHC Bronze Plus","67202LA001",,"LAN005","LAS005","LAF004","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_BronzePlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010004-03","Limited Cost Sharing Plan Variation",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040006","LAHC Gold","67202LA004",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040006-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010005","LAHC Catastrophic Plus","67202LA001",,"LAN005","LAS005","LAF005","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_CatastrophicPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040006","LAHC Gold","67202LA004",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040006-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040007","LAHC Silver","67202LA004",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040007-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0010005","LAHC Catastrophic Plus","67202LA001",,"LAN005","LAS005","LAF005","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_CatastrophicPlus_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/pos_individual.pdf","http://www.mylahc.org/formulary","67202LA0010005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020001","LAHC Platinum","67202LA002",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020001-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040007","LAHC Silver","67202LA004",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040007-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020001","LAHC Platinum","67202LA002",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020001-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040008","LAHC Bronze","67202LA004",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040008-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020001","LAHC Platinum","67202LA002",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"27"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040008","LAHC Bronze","67202LA004",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040008-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020001","LAHC Platinum","67202LA002",,"LAN001","LAS001","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020001-03","Limited Cost Sharing Plan Variation",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040009","LAHC Platinum","67202LA004",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040009-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040009","LAHC Platinum","67202LA004",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040009-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020002","LAHC Gold","67202LA002",,"LAN001","LAS001","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020002-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040012","LAHC Bronze","67202LA004",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040012-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"35"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-03","Limited Cost Sharing Plan Variation",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040013","LAHC Platinum","67202LA004",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040013-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-04","73% AV Level Silver Plan",,"0.723531305789948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040013","LAHC Platinum","67202LA004",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040013-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-05","87% AV Level Silver Plan",,"0.863806486129761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040014","LAHC Gold","67202LA004",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040014-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040014","LAHC Gold","67202LA004",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040014-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020003","LAHC Silver","67202LA002",,"LAN001","LAS001","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020003-06","94% AV Level Silver Plan",,"0.935929656028748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020004","LAHC Bronze","67202LA002",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020004-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040015","LAHC Silver","67202LA004",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040015-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020004","LAHC Bronze","67202LA002",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020004-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040015","LAHC Silver","67202LA004",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040015-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020004","LAHC Bronze","67202LA002",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"42"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040016","LAHC Bronze","67202LA004",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040016-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"42"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020004","LAHC Bronze","67202LA002",,"LAN001","LAS001","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020004-03","Limited Cost Sharing Plan Variation",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","SHOP (Small Group)","No","45-3188075","67202LA0040016","LAHC Bronze","67202LA004",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014ShopSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_group.pdf","http://www.mylahc.org/formulary","67202LA0040016-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020005","LAHC Catastrophic","67202LA002",,"LAN001","LAS001","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020005","LAHC Catastrophic","67202LA002",,"LAN001","LAS001","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020006","LAHC Platinum","67202LA002",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020006-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"46"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020006","LAHC Platinum","67202LA002",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020006-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"47"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020006","LAHC Platinum","67202LA002",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"48"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020006","LAHC Platinum","67202LA002",,"LAN002","LAS002","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020006-03","Limited Cost Sharing Plan Variation",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020007","LAHC Gold","67202LA002",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020007-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"50"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020007","LAHC Gold","67202LA002",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020007-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020007","LAHC Gold","67202LA002",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"52"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020007","LAHC Gold","67202LA002",,"LAN002","LAS002","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020007-03","Limited Cost Sharing Plan Variation",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"53"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"56"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-03","Limited Cost Sharing Plan Variation",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-04","73% AV Level Silver Plan",,"0.723531305789948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"58"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-05","87% AV Level Silver Plan",,"0.863806486129761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020008","LAHC Silver","67202LA002",,"LAN002","LAS002","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020008-06","94% AV Level Silver Plan",,"0.935929656028748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020009","LAHC Bronze","67202LA002",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020009-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020009","LAHC Bronze","67202LA002",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020009-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"62"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020009","LAHC Bronze","67202LA002",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"63"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020009","LAHC Bronze","67202LA002",,"LAN002","LAS002","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020009-03","Limited Cost Sharing Plan Variation",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"64"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020010","LAHC Catastrophic","67202LA002",,"LAN002","LAS002","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"65"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020010","LAHC Catastrophic","67202LA002",,"LAN002","LAS002","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020011","LAHC Platinum","67202LA002",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020011-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020011","LAHC Platinum","67202LA002",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020011-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"68"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020011","LAHC Platinum","67202LA002",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"69"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020011","LAHC Platinum","67202LA002",,"LAN003","LAS003","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020011-03","Limited Cost Sharing Plan Variation",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"70"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020012","LAHC Gold","67202LA002",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020012-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"71"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020012","LAHC Gold","67202LA002",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020012-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"72"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020012","LAHC Gold","67202LA002",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"73"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020012","LAHC Gold","67202LA002",,"LAN003","LAS003","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020012-03","Limited Cost Sharing Plan Variation",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"74"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"75"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"76"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"77"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-03","Limited Cost Sharing Plan Variation",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"78"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-04","73% AV Level Silver Plan",,"0.723531305789948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"79"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-05","87% AV Level Silver Plan",,"0.863806486129761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"80"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020013","LAHC Silver","67202LA002",,"LAN003","LAS003","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020013-06","94% AV Level Silver Plan",,"0.935929656028748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"81"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020014","LAHC Bronze","67202LA002",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020014-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"82"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020014","LAHC Bronze","67202LA002",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020014-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"83"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020014","LAHC Bronze","67202LA002",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"84"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020014","LAHC Bronze","67202LA002",,"LAN003","LAS003","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020014-03","Limited Cost Sharing Plan Variation",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"85"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020015","LAHC Catastrophic","67202LA002",,"LAN003","LAS003","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020015-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"86"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020015","LAHC Catastrophic","67202LA002",,"LAN003","LAS003","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"87"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020016","LAHC Platinum","67202LA002",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020016-00","Standard Platinum Off Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"88"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020016","LAHC Platinum","67202LA002",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020016-01","Standard Platinum On Exchange Plan",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"89"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020016","LAHC Platinum","67202LA002",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"90"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020016","LAHC Platinum","67202LA002",,"LAN004","LAS004","LAF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Platinum_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020016-03","Limited Cost Sharing Plan Variation",,"0.88054758310318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"91"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020017","LAHC Gold","67202LA002",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020017-00","Standard Gold Off Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"92"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020017","LAHC Gold","67202LA002",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020017-01","Standard Gold On Exchange Plan",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"93"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020017","LAHC Gold","67202LA002",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"94"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020017","LAHC Gold","67202LA002",,"LAN004","LAS004","LAF002","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Gold_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020017-03","Limited Cost Sharing Plan Variation",,"0.782181978225708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"95"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-00","Standard Silver Off Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"96"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-01","Standard Silver On Exchange Plan",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"97"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"98"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-03","Limited Cost Sharing Plan Variation",,"0.688694417476654","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"99"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-04","73% AV Level Silver Plan",,"0.723531305789948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"100"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-05","87% AV Level Silver Plan",,"0.863806486129761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"101"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020018","LAHC Silver","67202LA002",,"LAN004","LAS004","LAF003","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Silver_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020018-06","94% AV Level Silver Plan",,"0.935929656028748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"102"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020019","LAHC Bronze","67202LA002",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020019-00","Standard Bronze Off Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"103"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020019","LAHC Bronze","67202LA002",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020019-01","Standard Bronze On Exchange Plan",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"104"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020019","LAHC Bronze","67202LA002",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"105"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020019","LAHC Bronze","67202LA002",,"LAN004","LAS004","LAF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Bronze_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020019-03","Limited Cost Sharing Plan Variation",,"0.612048447132111","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"106"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020020","LAHC Catastrophic","67202LA002",,"LAN004","LAS004","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020020-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","LA","67202","HIOS","9","2014-01-15 07:08:32","1","67202","LA","Individual","No","45-3188075","67202LA0020020","LAHC Catastrophic","67202LA002",,"LAN004","LAS004","LAF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"3","3","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.mylahc.org/Files/Repository/LAHC_Catastrophic_2014IndSBC.PDF","https://auth.iwillbill.com/opensso/Consumer/metaAlias/louisiana/ffm","http://www.mylahc.org/Images/Interior/insurancedocuments/hmo_individual.pdf","http://www.mylahc.org/formulary","67202LA0020020-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090001","AAA011 Vantage Individual Marketplace Platinum","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$2.19","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090001-00","Standard Platinum Off Exchange Plan","89.32%","0.884151518344879","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$2,280","$0","$150","$0","$580","$230","$40","4"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100001","AAA011 Vantage Group Marketplace Platinum","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100001-00","Standard Platinum Off Exchange Plan","89.32%","0.884151518344879","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$2,280","$0","$150","$0","$580","$230","$40","4"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100001","AAA011 Vantage Group Marketplace Platinum","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100001-01","Standard Platinum On Exchange Plan","89.32%","0.884151518344879","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$2,280","$0","$150","$0","$580","$230","$40","5"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090001","AAA011 Vantage Individual Marketplace Platinum","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$2.19","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090001-01","Standard Platinum On Exchange Plan","89.32%","0.884151518344879","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$2,280","$0","$150","$0","$580","$230","$40","5"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100002","AAA012 Vantage Group Marketplace Gold","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100002-00","Standard Gold Off Exchange Plan","78.68%","0.820090174674988","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$2,780","$0","$150","$1,000","$610","$80","$40","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340011","Blue Max 70/50 $3000","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340011-00","Standard Bronze Off Exchange Plan",,"0.616786897182465","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$3,000","$0","$1,284","$150","$3,000","$0","$681","$79","15"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340011","Blue Max 70/50 $3000","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340011-01","Standard Bronze On Exchange Plan",,"0.616786897182465","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$3,000","$0","$1,284","$150","$3,000","$0","$681","$79","16"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1300","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Gold","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1300","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Gold","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350001-03","Limited Cost Sharing Plan Variation","81.60%","0.816470444202423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","0%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$0","$150","$1,300","$0","$0","$79","30"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-01","Standard Silver On Exchange Plan",,"0.71539831161499","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","$3,641","$150","$0","$0","$2,635","$79","9"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-03","Limited Cost Sharing Plan Variation",,"0.71539831161499","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","$3,641","$150","$0","$0","$2,635","$79","11"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-04","73% AV Level Silver Plan",,"0.735449135303497","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,000","$24,000","$16,900","$33,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","$3,641","$150","$0","$0","$2,635","$79","12"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"78461LA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010003","BEST Dental Advantage - Gold","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"78461LA0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","Individual","Yes","95-6042390","78461LA0020003","BESTOne Dental Advantage - Gold","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"78461LA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010003","BEST Dental Advantage - Gold","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"78461LA0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"78461LA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010004","BEST Dental Plus - Gold","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Plus_Plan_(Gold).pdf",,"78461LA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010004","BEST Dental Plus - Gold","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Plus_Plan_(Gold).pdf",,"78461LA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","3","78461","LA","Individual","Yes","95-6042390","78461LA0020004","BESTOne Dental Plus - Gold","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"78461LA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010005","BEST Dental Plus - Silver","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Plus_Plan_(Silver).pdf",,"78461LA0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090001","AAA011 Vantage Individual Marketplace Platinum","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$2.19","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$0","6"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","Individual","Yes","95-6042390","78461LA0020005","BESTOne Dental Plus - Silver","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"78461LA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010006","BEST Dental Basic - Silver","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Basic_Plan_(Silver).pdf",,"78461LA0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","Individual","Yes","95-6042390","78461LA0020006","BESTOne Dental Basic - Silver","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"78461LA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","Individual","Yes","95-6042390","78461LA0020006","BESTOne Dental Basic - Silver","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"78461LA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010006","BEST Dental Basic - Silver","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Basic_Plan_(Silver).pdf",,"78461LA0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","86868","HIOS","4","2013-08-30 07:44:10","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010001","DentalConnect�","86868LA001",,"LAN001","LAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86868LA0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","86868","HIOS","4","2013-08-30 07:44:10","1","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010002","DentalConnect�","86868LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86868LA0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","86868","HIOS","4","2013-08-30 07:44:10","2","86868","LA","SHOP (Small Group)","Yes","35-0472300","86868LA0010003","DentalConnect�","86868LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86868LA0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0010001","Guardian Pediatric Advantage","87390LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0010001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-06","94% AV Level Silver Plan",,"0.937422037124634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","$364","$150","$0","$0","$264","$79","14"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-00","Standard Silver Off Exchange Plan",,"0.700365960597992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","31"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-01","Standard Silver On Exchange Plan",,"0.700365960597992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","32"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340011","Blue Max 70/50 $3000","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-00","Standard Silver Off Exchange Plan","70.00%","0.692615151405334","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500","30%",,,,"$5,000","$15,000","$7,500","$22,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$2,523","$0","$1,428","$150","$1,772","$924","$0","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-01","Standard Silver On Exchange Plan","70.00%","0.692615151405334","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500","30%",,,,"$5,000","$15,000","$7,500","$22,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$2,523","$0","$1,428","$150","$1,772","$924","$0","$79","9"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100002","AAA012 Vantage Group Marketplace Gold","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100002-01","Standard Gold On Exchange Plan","78.68%","0.820090174674988","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$2,780","$0","$150","$1,000","$610","$80","$40","7"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090001","AAA011 Vantage Individual Marketplace Platinum","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Platinum","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$2.19","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090001-03","Limited Cost Sharing Plan Variation","89.32%","0.884151518344879","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$2,280","$0","$150","$0","$580","$230","$40","7"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090002","AAA012 Vantage Individual Marketplace Gold","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$4.58","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090002-00","Standard Gold Off Exchange Plan","78.68%","0.820090174674988","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$2,780","$0","$150","$1,000","$610","$80","$40","8"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100003","AAA013 Vantage Group Marketplace Silver","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100003-00","Standard Silver Off Exchange Plan","71.84%","0.745696485042572","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","8"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100003","AAA013 Vantage Group Marketplace Silver","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100003-01","Standard Silver On Exchange Plan","71.84%","0.745696485042572","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","9"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090002","AAA012 Vantage Individual Marketplace Gold","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$4.58","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090002-01","Standard Gold On Exchange Plan","78.68%","0.820090174674988","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$2,780","$0","$150","$1,000","$610","$80","$40","9"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090002","AAA012 Vantage Individual Marketplace Gold","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$4.58","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$40","10"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100004","AAA014 Vantage Group Marketplace Bronze","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100004-00","Standard Bronze Off Exchange Plan","61.99%","0.671014130115509","No","No","No","100%",,"$4,350","$8,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,350","$4,350","100%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$4,000","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,350","$60","$0","$150","$1,420","$2,180","$0","$40","10"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090002","AAA012 Vantage Individual Marketplace Gold","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Gold","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$4.58","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090002-03","Limited Cost Sharing Plan Variation","78.68%","0.820090174674988","No","No","No","100%",,"$5,850","$11,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$2,780","$0","$150","$1,000","$610","$80","$40","11"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","SHOP (Small Group)","No","72-1285173","67243LA0100004","AAA014 Vantage Group Marketplace Bronze","67243LA010",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction; LASIK surgery; Radial keratotomy",,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972238508287237",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0100004-01","Standard Bronze On Exchange Plan","61.99%","0.671014130115509","No","No","No","100%",,"$4,350","$8,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,350","$4,350","100%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$4,000","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,350","$60","$0","$150","$1,420","$2,180","$0","$40","11"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-00","Standard Silver Off Exchange Plan","71.84%","0.745696485042572","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","12"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-01","Standard Silver On Exchange Plan","71.84%","0.745696485042572","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","13"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$40","14"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-03","Limited Cost Sharing Plan Variation","71.84%","0.745696485042572","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","15"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-04","73% AV Level Silver Plan","73.88%","0.768157958984375","No","No","No","100%",,"$4,100","$8,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,800","$1,980","$0","$150","$1,420","$960","$0","$40","16"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-05","87% AV Level Silver Plan","87.24%","0.881556212902069","No","No","No","100%",,"$1,715","$3,430",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$1,250","$0","$150","$500","$440","$90","$40","17"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090003","AAA013 Vantage Individual Marketplace Silver","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Silver","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$6.09","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"3","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090003-06","94% AV Level Silver Plan","94.62%","0.936161696910858","No","No","No","100%",,"$1,715","$3,430",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","5%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,"$100","$310","$0","$150","$100","$210","$70","$40","18"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090004","AAA014 Vantage Individual Marketplace Bronze","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$8.29","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090004-00","Standard Bronze Off Exchange Plan","61.99%","0.671014130115509","No","No","No","100%",,"$4,350","$8,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,350","$8,700","100%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$4,000","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,350","$60","$0","$150","$1,420","$2,180","$0","$40","19"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090004","AAA014 Vantage Individual Marketplace Bronze","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$8.29","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090004-01","Standard Bronze On Exchange Plan","61.99%","0.671014130115509","No","No","No","100%",,"$4,350","$8,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,350","$8,700","100%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$4,000","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,350","$60","$0","$150","$1,420","$2,180","$0","$40","20"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090004","AAA014 Vantage Individual Marketplace Bronze","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$8.29","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$40","21"
"2014","LA","67243","HIOS","9","2014-01-21 08:29:49","1","67243","LA","Individual","No","72-1285173","67243LA0090004","AAA014 Vantage Individual Marketplace Bronze","67243LA009",,"LAN001","LAS001","LAF001","New","POS","Bronze","Yes","Both","Yes","No",,"Services that are not Medically Necessary; Non-authorized services which require pre-authorization; Breast and penile implants; Treatment of complications secondary to weight loss surgery; Treatment of complications from or removal of tattoos; Sex transformations; Transportation; Marriage/family counseling; Physical therapy for chronic or recurring conditions; Pulmonary rehabilitation; Drug screenings; Non-prescription drugs; Medications for erectile dysfunction","$8.29","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.972550753849591",,,"0","0","0","2014-01-01",,"Yes","Out-of-country coverage mirrors Benchmark plan.","Yes","This is a point-of-service plan and out-of-service area services are covered.  The provider network determines the member's cost share.","No","http://vhpla.com/Reform/PlanDocuments","https://portal.vantagehealthplan.com/HIXPayment","http://vhpla.com/Reform/PlanDocuments","http://www.vhpla.com/marketplace/","67243LA0090004-03","Limited Cost Sharing Plan Variation","61.99%","0.671014130115509","No","No","No","100%",,"$4,350","$8,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,350","$8,700","100%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$4,000","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,350","$60","$0","$150","$1,420","$2,180","$0","$40","22"
"2014","LA","75409","HIOS","1","2013-06-05 12:49:14","1","75409","LA","SHOP (Small Group)","Yes","13-5581829","75409LA0150001","EHB Basic Dental Plan (Low)","75409LA015",,"LAN001","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$16.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"75409LA0150001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","75409","HIOS","1","2013-06-05 12:49:14","2","75409","LA","SHOP (Small Group)","Yes","13-5581829","75409LA0160001","EHB Enhanced Dental Plan (High)","75409LA016",,"LAN002","LAS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$20.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"75409LA0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","75409","HIOS","1","2013-06-05 12:49:14","3","75409","LA","SHOP (Small Group)","Yes","13-5581829","75409LA0170001","Family Basic Dental Plan (Low)","75409LA017",,"LAN003","LAS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$16.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"75409LA0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","75409","HIOS","1","2013-06-05 12:49:14","4","75409","LA","SHOP (Small Group)","Yes","13-5581829","75409LA0180001","Family Enhanced Dental Plan (High)","75409LA018",,"LAN004","LAS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"75409LA0180001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","1","78461","LA","Individual","Yes","95-6042390","78461LA0020001","BESTOne Child Dental Plus","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Child_Dental_Plus_Plan.pdf",,"78461LA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010001","BEST Life Child Dental Plus","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Child_Dental_Plus_Plan.pdf",,"78461LA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","1","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010001","BEST Life Child Dental Plus","78461LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Child_Dental_Plus_Plan.pdf",,"78461LA0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","1","78461","LA","Individual","Yes","95-6042390","78461LA0020001","BESTOne Child Dental Plus","78461LA002",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Child_Dental_Plus_Plan.pdf",,"78461LA0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010002","BEST Life Child Dental","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Child_Dental_Plan.pdf",,"78461LA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","2","78461","LA","Individual","Yes","95-6042390","78461LA0020002","BESTOne Child Dental","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Child_Dental_Plan.pdf",,"78461LA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","2","78461","LA","Individual","Yes","95-6042390","78461LA0020002","BESTOne Child Dental","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Child_Dental_Plan.pdf",,"78461LA0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","2","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010002","BEST Life Child Dental","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Child_Dental_Plan.pdf",,"78461LA0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","Individual","Yes","95-6042390","78461LA0020005","BESTOne Dental Plus - Silver","78461LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"78461LA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","78461","HIOS","8","2014-01-21 08:29:49","4","78461","LA","SHOP (Small Group)","Yes","95-6042390","78461LA0010005","BEST Dental Plus - Silver","78461LA001",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/LA/pdf/LA_BEST_Dental_Plus_Plan_(Silver).pdf",,"78461LA0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0010001","Guardian Pediatric Advantage","87390LA001",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0010001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-05","87% AV Level Silver Plan",,"0.867890000343323","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$12,000","$24,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","$1,820","$150","$0","$0","$1,318","$79","13"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340004","Blue Max copay 80/60 $750","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340004-03","Limited Cost Sharing Plan Variation","81.20%","0.805073976516724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,302","$150","$750","$530","$104","$79","15"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360001","Group Care copay 70/50 $500A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360001-00","Standard Gold Off Exchange Plan","80.60%","0.801743745803833","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","30%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360001","Group Care copay 70/50 $500A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360001-01","Standard Gold On Exchange Plan","80.60%","0.801743745803833","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","30%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400002","Blue Dental Preferred - $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040","7780687910","LAN002","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.11",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/group-bluedental-brochure",,"97176LA0400002-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred - $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039","7780687910","LAN002","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.73",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-bluedental-brochure",,"97176LA0390002-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340002","Blue Max 70/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340002-03","Limited Cost Sharing Plan Variation",,"0.791486501693726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","$2,184","$150","$0","$0","$1,581","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340007","Blue Max 50/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF007","New","PPO","Silver","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340007-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340007-00","Standard Silver Off Exchange Plan",,"0.71539831161499","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","$3,641","$150","$0","$0","$2,635","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360011","Group Care 80/60 $1500A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360011-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360011-01","Standard Silver On Exchange Plan","71.60%","0.716034591197968","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,500","$4,000","20%",,,,"$3,000","$9,000","$4,500","$13,000","$100","$300","10%",,,,"$100","$300","$100","$300",,,,,,,,,,,"$1,500","$0","$1,152","$150","$1,500","$600","$184","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340005","Blue Max copay 80/60 $1000","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360002","Group Care copay 70/50 $500B","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360002-00","Standard Gold Off Exchange Plan","80.20%","0.795923590660095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","30%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360002","Group Care copay 70/50 $500B","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360002-01","Standard Gold On Exchange Plan","80.20%","0.795923590660095","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","30%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-05","87% AV Level Silver Plan","86.50%","0.865523159503937","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","0%",,,,"$5,600","$11,200","$6,400","$12,800","$800","$0","$0","$150","$800","$0","$0","$79","43"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-06","94% AV Level Silver Plan","93.60%","0.93625795841217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400",,,,,,,,,,,,,,,,,,,,,"$200","$400","0%",,,,"$5,600","$11,200","$5,800","$11,600","$200","$0","$0","$150","$200","$0","$0","$79","44"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 70/50 $3300","97176LA035","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350004-00","Standard Bronze Off Exchange Plan",,"0.610984742641449","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600","30%",,,,"$6,600","$13,200","$9,900","$19,800","$3,300","$0","$1,194","$150","$3,300","$0","$591","$79","45"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360010-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360010-01","Standard Gold On Exchange Plan","80.50%","0.797687530517578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$1,000","$280","$54","$79","17"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2000","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360013-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360013-00","Standard Silver Off Exchange Plan","71.60%","0.708419740200043","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","30%",,,,"$4,000","$12,000","$6,000","$16,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,578","$150","$2,000","$600","$126","$79","18"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","Individual","No","86-0257201","32753MO0770006","Anthem Bronze DirectAccess w/Child Dental - cdbr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2L","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770006-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","Individual","No","86-0257201","32753MO0770006","Anthem Bronze DirectAccess w/Child Dental - cdbr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2L","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340004","Blue Max copay 80/60 $750","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340004-01","Standard Gold On Exchange Plan","81.20%","0.805073976516724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,302","$150","$750","$530","$104","$79","13"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360003","Group Care copay 80/60 $500","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360003-00","Standard Gold Off Exchange Plan","81.30%","0.805948436260223","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340011","Blue Max 70/50 $3000","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340011-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340011-03","Limited Cost Sharing Plan Variation",,"0.616786897182465","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"$6,000","$18,000","$9,000","$27,000","$3,000","$0","$1,284","$150","$3,000","$0","$681","$79","18"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340012","Blue Max 80/60 $4000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340012-00","Standard Bronze Off Exchange Plan",,"0.603681147098541","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000","20%",,,,"$8,000","$24,000","$12,000","$36,000","$4,000","$0","$656","$150","$4,000","$0","$254","$79","19"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340012","Blue Max 80/60 $4000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340012-01","Standard Bronze On Exchange Plan",,"0.603681147098541","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000","20%",,,,"$8,000","$24,000","$12,000","$36,000","$4,000","$0","$656","$150","$4,000","$0","$254","$79","20"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340012","Blue Max 80/60 $4000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340012","Blue Max 80/60 $4000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340012-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340012-03","Limited Cost Sharing Plan Variation",,"0.603681147098541","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$12,000","20%",,,,"$8,000","$24,000","$12,000","$36,000","$4,000","$0","$656","$150","$4,000","$0","$254","$79","22"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340013","Blue Max 80/60 $5000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340013-00","Standard Bronze Off Exchange Plan",,"0.586139976978302","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","$15,000","$38,100","$5,000","$0","$456","$150","$5,000","$0","$54","$79","23"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340013","Blue Max 80/60 $5000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340013-01","Standard Bronze On Exchange Plan",,"0.586139976978302","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","$15,000","$38,100","$5,000","$0","$456","$150","$5,000","$0","$54","$79","24"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340013","Blue Max 80/60 $5000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","25"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340013","Blue Max 80/60 $5000","97176LA034","7780687910","LAN001","LAS001","LAF008","New","PPO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340013-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340013-03","Limited Cost Sharing Plan Variation",,"0.586139976978302","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","$15,000","$38,100","$5,000","$0","$456","$150","$5,000","$0","$54","$79","26"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1300","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Gold","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350001-00","Standard Gold Off Exchange Plan","81.60%","0.816470444202423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","0%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$0","$150","$1,300","$0","$0","$79","27"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350001","Blue Saver 100/80 $1300","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Gold","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350001-01","Standard Gold On Exchange Plan","81.60%","0.816470444202423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","0%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$0","$150","$1,300","$0","$0","$79","28"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0020001","Guardian Pediatric Essentials","87390LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0020001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","1","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0020001","Guardian Pediatric Essentials","87390LA002",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0020001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0030001","Guardian Family Advantage Plus","87390LA003",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0030001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","2","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0030001","Guardian Family Advantage Plus","87390LA003",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0030001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","3","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0050001","Guardian Family Essentials Plus","87390LA005",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0050001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","3","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0050001","Guardian Family Essentials Plus","87390LA005",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0050001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","4","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0040001","Guardian Family Advantage","87390LA004",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0040001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","4","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0040001","Guardian Family Advantage","87390LA004",,"LAN001","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0040001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","4","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0060001","Guardian Family Essentials","87390LA006",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0060001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","87390","HIOS","6","2013-09-13 08:31:59","4","87390","LA","SHOP (Small Group)","Yes","13-5123390","87390LA0060001","Guardian Family Essentials","87390LA006",,"LAN001","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"87390LA0060001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400001","Blue Dental Essential - $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA040","7780687910","LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/group-bluedental-brochure",,"97176LA0400001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0370001","Blue Saver 80/60 $1900","97176LA037","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0370001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0370001-00","Standard Silver Off Exchange Plan","70.00%","0.700365960597992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340002","Blue Max 70/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340002-00","Standard Gold Off Exchange Plan",,"0.791486501693726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$1,000","$3,000","$1,000","$3,000","$0","$0","$2,184","$150","$0","$0","$1,581","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential - $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA039","7780687910","LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.24",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-bluedental-brochure",,"97176LA0390001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0370001","Blue Saver 80/60 $1900","97176LA037","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0370001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0370001-01","Standard Silver On Exchange Plan","70.00%","0.700365960597992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400001","Blue Dental Essential - $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA040","7780687910","LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/group-bluedental-brochure",,"97176LA0400001-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","Yes","23-7384555","97176LA0390001","Blue Dental Essential - $1,000 Annual Benefit Maximum per Adult, 100%/50% coinsurance, $75 deductible","97176LA039","7780687910","LAN002","LAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.24",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-bluedental-brochure",,"97176LA0390001-01","Standard Low On Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340002","Blue Max 70/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340002-01","Standard Gold On Exchange Plan",,"0.791486501693726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","$2,184","$150","$0","$0","$1,581","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0370002","Blue Saver 70/50 $3300","97176LA037","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0370002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0370002-00","Standard Bronze Off Exchange Plan","61.00%","0.609980046749115","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600","30%",,,,"$6,600","$13,200","$9,900","$19,800","$3,300","$0","$1,194","$150","$3,300","$0","$591","$79","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","Yes","23-7384555","97176LA0390002","Blue Dental Preferred - $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA039","7780687910","LAN002","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.73",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-bluedental-brochure",,"97176LA0390002-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","Yes","23-7384555","97176LA0400002","Blue Dental Preferred - $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible","97176LA040","7780687910","LAN002","LAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.11",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage available for covered benefits","Yes",,"http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/group-bluedental-brochure",,"97176LA0400002-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0340002","Blue Max 70/50 $0","97176LA034","7780687910","LAN001","LAS001","LAF005","New","PPO","Gold","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0370002","Blue Saver 70/50 $3300","97176LA037","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0370002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0370002-01","Standard Bronze On Exchange Plan","61.00%","0.609980046749115","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600","30%",,,,"$6,600","$13,200","$9,900","$19,800","$3,300","$0","$1,194","$150","$3,300","$0","$591","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340005","Blue Max copay 80/60 $1000","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340005-03","Limited Cost Sharing Plan Variation","79.90%","0.79078209400177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$1,023","$0","$1,252","$150","$1,250","$673","$54","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","33"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-03","Limited Cost Sharing Plan Variation",,"0.700365960597992","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,100","$8,200",,,"$8,200","$16,400","$12,300","$24,600",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","34"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-04","73% AV Level Silver Plan",,"0.729028105735779","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,200","$16,400","$11,200","$22,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,076","$150","$1,900","$0","$674","$79","35"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-05","87% AV Level Silver Plan",,"0.86478316783905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$8,200","$16,400","$9,600","$19,200",,,,,,,,,,,,,,,,,,,,,"$400","$800","20%",,,,"$3,800","$7,600","$4,200","$8,400","$400","$0","$1,000","$150","$400","$0","$974","$79","36"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350002","Blue Saver 80/60 $1900","97176LA035","7780687910","LAN001","LAS001","LAF008","New","PPO","Silver","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350002-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350002-06","94% AV Level Silver Plan",,"0.935482263565063","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$8,200","$16,400","$9,600","$19,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$3,800","$7,600","$3,800","$7,600","$0","$0","$364","$150","$0","$0","$264","$79","37"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-00","Standard Silver Off Exchange Plan","70.20%","0.701616883277893","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"$5,600","$11,200","$8,400","$16,800","$2,800","$0","$0","$150","$2,800","$0","$0","$79","38"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-01","Standard Silver On Exchange Plan","70.20%","0.701616883277893","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"$5,600","$11,200","$8,400","$16,800","$2,800","$0","$0","$150","$2,800","$0","$0","$79","39"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","40"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-03","Limited Cost Sharing Plan Variation","70.20%","0.701616883277893","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"$5,600","$11,200","$8,400","$16,800","$2,800","$0","$0","$150","$2,800","$0","$0","$79","41"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350003","Blue Saver 100/80 $2800","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350003-04","73% AV Level Silver Plan","73.40%","0.733762919902802","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","$12,500","$25,000",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","0%",,,,"$5,600","$11,200","$7,900","$15,800","$2,300","$0","$0","$150","$2,300","$0","$0","$79","42"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360011","Group Care 80/60 $1500A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360011-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360011-00","Standard Silver Off Exchange Plan","71.60%","0.716034591197968","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,500","$4,000","20%",,,,"$3,000","$9,000","$4,500","$13,000","$100","$300","10%",,,,"$100","$300","$100","$300",,,,,,,,,,,"$1,500","$0","$1,152","$150","$1,500","$600","$184","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340005","Blue Max copay 80/60 $1000","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340005-01","Standard Gold On Exchange Plan","79.90%","0.79078209400177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$1,023","$0","$1,252","$150","$1,250","$673","$54","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-03","Limited Cost Sharing Plan Variation","70.00%","0.692615151405334","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$7,500","30%",,,,"$5,000","$15,000","$7,500","$22,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$2,523","$0","$1,428","$150","$1,772","$924","$0","$79","11"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-04","73% AV Level Silver Plan","72.60%","0.719586133956909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$25,400","$17,200","$34,400","$2,500","$7,500","30%",,,,"$5,000","$15,000","$7,500","$22,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$2,523","$0","$1,428","$150","$1,772","$924","$0","$79","12"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340004","Blue Max copay 80/60 $750","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360006","Group Care copay 80/60 $750A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360006-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360006-01","Standard Gold On Exchange Plan","79.30%","0.786491394042969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","$14,250","$28,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","13"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360009","Group Care copay 70/50 $1000A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360009-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360009-00","Standard Gold Off Exchange Plan","79.90%","0.792908787727356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","30%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$100","$280","$54","$79","14"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360009","Group Care copay 70/50 $1000A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360009-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360009-01","Standard Gold On Exchange Plan","79.90%","0.792908787727356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","30%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$100","$280","$54","$79","15"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360010","Group Care copay 80/60 $1000","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360010-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360010-00","Standard Gold Off Exchange Plan","80.50%","0.797687530517578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$1,000","$280","$54","$79","16"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0810002","Anthem Dental Pediatric Enhanced","32753MO081",,"MON001","MOS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e213347.pdf",,,,"32753MO0810002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","Individual","Yes","86-0257201","32753MO0840002","Anthem Dental Pediatric Enhanced","32753MO084",,"MON001","MOS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e213347.pdf",,,,"32753MO0840002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0830001","Anthem Dental Family","32753MO083",,"MON001","MOS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.66",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212893.pdf",,,,"32753MO0830001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","Individual","Yes","86-0257201","32753MO0860002","Anthem Dental Family Enhanced","32753MO086",,"MON001","MOS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212894.pdf",,,,"32753MO0860002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","Individual","No","86-0257201","32753MO0770012","Anthem Gold DirectAccess w/Child Dental - cdcp","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2P","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0830002","Anthem Dental Family Enhanced","32753MO083",,"MON001","MOS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212894.pdf",,,,"32753MO0830002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","Individual","No","86-0257201","32753MO0770012","Anthem Gold DirectAccess w/Child Dental - cdcp","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2P","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770012-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770001","Anthem Bronze DirectAccess - caaa","32753MO077",,"MON001","MOS001","MOF019","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9A","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770001-01","Standard Bronze On Exchange Plan","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780002","Anthem Silver Direct Access Plus-gfpa","32753MO078",,"MON002","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.988988126197446",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/mo","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0780002-01","Standard Silver On Exchange Plan","69.39%","0.695162057876587","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770001","Anthem Bronze DirectAccess - caaa","32753MO077",,"MON001","MOS001","MOF019","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9A","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770001","Anthem Bronze DirectAccess - caaa","32753MO077",,"MON001","MOS001","MOF019","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9A","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770001-03","Limited Cost Sharing Plan Variation","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770002","Anthem Bronze DirectAccess - caae","32753MO077",,"MON001","MOS001","MOF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9C","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770002-01","Standard Bronze On Exchange Plan","60.43%","0.624035477638245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"$12,100","$24,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 70/50 $3300","97176LA035","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350004-01","Standard Bronze On Exchange Plan",,"0.610984742641449","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600","30%",,,,"$6,600","$13,200","$9,900","$19,800","$3,300","$0","$1,194","$150","$3,300","$0","$591","$79","46"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 70/50 $3300","97176LA035","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","47"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350004","Blue Saver 70/50 $3300","97176LA035","7780687910","LAN001","LAS001","LAF005","New","PPO","Bronze","No","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350004-03","Limited Cost Sharing Plan Variation",,"0.610984742641449","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,200","$18,900","$37,800",,,,,,,,,,,,,,,,,,,,,"$3,300","$6,600","30%",,,,"$6,600","$13,200","$9,900","$19,800","$3,300","$0","$1,194","$150","$3,300","$0","$591","$79","48"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5000","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350005-00","Standard Bronze Off Exchange Plan","60.90%","0.609445869922638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$10,000","$20,000","$15,000","$30,000","$5,000","$0","$0","$150","$5,000","$0","$0","$79","49"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5000","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350005-01","Standard Bronze On Exchange Plan","60.90%","0.609445869922638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$10,000","$20,000","$15,000","$30,000","$5,000","$0","$0","$150","$5,000","$0","$0","$79","50"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5000","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","51"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","1","97176","LA","Individual","No","23-7384555","97176LA0350005","Blue Saver 100/80 $5000","97176LA035","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0350005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0350005-03","Limited Cost Sharing Plan Variation","60.90%","0.609445869922638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$10,000","$20,000","$15,000","$30,000","$5,000","$0","$0","$150","$5,000","$0","$0","$79","52"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380003","Premier Blue copay 50/50 $2000","97176LA038","7780687910","LAN001","LAS001","LAF003","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380003-00","Standard Silver Off Exchange Plan","71.10%","0.704034030437469","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","50%",,,,"$4,000","$12,000","$6,000","$16,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$2,000","$55","$1,236","$150","$2,000","$985","$0","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","Individual","No","23-7384555","97176LA0340014","Blue Max copay 100/80 $6250","97176LA034","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340014-00","Standard Bronze Off Exchange Plan","60.80%","0.614407896995544","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700","0%",,,,"$12,500","$25,400","$18,750","$38,100","$6,250","$0","$0","$150","$4,121","$500","$0","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380003","Premier Blue copay 50/50 $2000","97176LA038","7780687910","LAN001","LAS001","LAF003","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380003-01","Standard Silver On Exchange Plan","71.10%","0.704034030437469","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","50%",,,,"$4,000","$12,000","$6,000","$16,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$2,000","$55","$1,236","$150","$2,000","$985","$0","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","Individual","No","23-7384555","97176LA0340014","Blue Max copay 100/80 $6250","97176LA034","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340014-01","Standard Bronze On Exchange Plan","60.80%","0.614407896995544","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700","0%",,,,"$12,500","$25,400","$18,750","$38,100","$6,250","$0","$0","$150","$4,121","$500","$0","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","Individual","No","23-7384555","97176LA0340014","Blue Max copay 100/80 $6250","97176LA034","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","2","97176","LA","Individual","No","23-7384555","97176LA0340014","Blue Max copay 100/80 $6250","97176LA034","7780687910","LAN001","LAS001","LAF006","New","PPO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340014-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-2tier-formulary","97176LA0340014-03","Limited Cost Sharing Plan Variation","60.80%","0.614407896995544","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,700","0%",,,,"$12,500","$25,400","$18,750","$38,100","$6,250","$0","$0","$150","$4,121","$500","$0","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-00","Standard Silver Off Exchange Plan","70.80%","0.708351790904999","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500","30%",,,,"$3,000","$9,000","$4,500","$13,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,523","$0","$1,728","$150","$2,000","$524","$276","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360012","Group Care copay 60/40 $1500","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360012-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360012-00","Standard Silver Off Exchange Plan","70.90%","0.701191961765289","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,500","$4,000","40%",,,,"$3,000","$9,000","$4,500","$13,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$1,500","$0","$1,152","$150","$1,500","$600","$184","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-01","Standard Silver On Exchange Plan","70.80%","0.708351790904999","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500","30%",,,,"$3,000","$9,000","$4,500","$13,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,523","$0","$1,728","$150","$2,000","$524","$276","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360012","Group Care copay 60/40 $1500","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360012-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360012-01","Standard Silver On Exchange Plan","70.90%","0.701191961765289","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$1,500","$4,000","40%",,,,"$3,000","$9,000","$4,500","$13,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$1,500","$0","$1,152","$150","$1,500","$600","$184","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-03","Limited Cost Sharing Plan Variation","70.80%","0.708351790904999","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$1,500","$4,500","30%",,,,"$3,000","$9,000","$4,500","$13,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,523","$0","$1,728","$150","$2,000","$524","$276","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-04","73% AV Level Silver Plan","73.20%","0.732662618160248","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$4,500","30%",,,,"$3,000","$9,000","$4,500","$13,500","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$1,523","$0","$1,728","$150","$2,000","$524","$276","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-05","87% AV Level Silver Plan","86.40%","0.864212036132813","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400","$250","$750","30%",,,,"$3,000","$9,000","$3,250","$9,750","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$250","$0","$1,450","$150","$750","$245","$651","$79","9"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","3","97176","LA","Individual","No","23-7384555","97176LA0340008","Blue Max 70/50 $1500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340008-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340008-06","94% AV Level Silver Plan","93.80%","0.938082277774811","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,000","$20,000","$11,700","$23,400","$0","$0","5%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$23","$0","$363","$150","$500","$245","$121","$79","10"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340005","Blue Max copay 80/60 $1000","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340005-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340005-00","Standard Gold Off Exchange Plan","79.90%","0.79078209400177","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$250","$750","10%",,,,"$250","$750","$250","$750",,,,,,,,,,,"$1,023","$0","$1,252","$150","$1,250","$673","$54","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-05","87% AV Level Silver Plan","86.60%","0.86182028055191","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$400","$1,200","20%",,,,"$5,000","$15,000","$5,400","$16,200","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$423","$0","$1,372","$150","$900","$445","$174","$79","13"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","4","97176","LA","Individual","No","23-7384555","97176LA0340010","Blue Max copay 70/50 $2500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340010-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340010-06","94% AV Level Silver Plan","93.90%","0.939265310764313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,700","$25,400","$14,850","$29,700","$100","$300","0%",,,,"$5,000","$15,000","$5,100","$15,300","$500","$1,500","10%",,,,"$500","$1,500","$500","$1,500",,,,,,,,,,,"$123","$0","$0","$150","$600","$445","$0","$79","14"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340001","Blue Max copay 80/60 $250","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Platinum","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340001-00","Standard Platinum Off Exchange Plan","88.80%","0.884273827075958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$250","$750","20%",,,,"$1,000","$3,000","$1,250","$3,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$250","$0","$1,250","$150","$250","$430","$204","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380001","Premier Blue copay 80/60 $500A","97176LA038","7780687910","LAN001","LAS001","LAF003","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380001-00","Standard Gold Off Exchange Plan","80.60%","0.800082266330719","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","Individual","Yes","95-6042390","29416MO0020003","BESTOne Dental Advantage - Gold","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"29416MO0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010003","BEST Dental Advantage - Gold","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Advantage_Plan_(Gold).pdf",,"29416MO0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","Individual","Yes","95-6042390","29416MO0020004","BESTOne Dental Plus - Gold","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"29416MO0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010004","BEST Dental Plus - Gold","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Plus_Plan_(Gold).pdf",,"29416MO0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010004","BEST Dental Plus - Gold","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Plus_Plan_(Gold).pdf",,"29416MO0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","Individual","Yes","95-6042390","29416MO0020004","BESTOne Dental Plus - Gold","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"29416MO0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010005","BEST Dental Plus - Silver","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Plus_Plan_(Silver).pdf",,"29416MO0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","Individual","Yes","95-6042390","29416MO0020005","BESTOne Dental Plus - Silver","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"29416MO0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010005","BEST Dental Plus - Silver","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Plus_Plan_(Silver).pdf",,"29416MO0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","Individual","Yes","95-6042390","29416MO0020005","BESTOne Dental Plus - Silver","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"29416MO0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010006","BEST Dental Basic - Silver","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Basic_Plan_(Silver).pdf",,"29416MO0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","Individual","Yes","95-6042390","29416MO0020006","BESTOne Dental Basic - Silver","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"29416MO0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","4","44240","MO","Individual","No","75-1296086","44240MO0090005","Catastrophic 100% PPO Exchange","44240MO009",,"MON001","MOS001","MOF006","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72403","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","5","44240","MO","Individual","No","75-1296086","44240MO0090007","Gold $0 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72420","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090007-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","$9,400","$18,800","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$3,750","$7,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","5","44240","MO","Individual","No","75-1296086","44240MO0090007","Gold $0 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72420","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","5","44240","MO","Individual","No","75-1296086","44240MO0090007","Gold $0 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72420","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090007-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","$9,400","$18,800","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$3,750","$7,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380001","Premier Blue copay 80/60 $500A","97176LA038","7780687910","LAN001","LAS001","LAF003","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380001-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380001-01","Standard Gold On Exchange Plan","80.60%","0.800082266330719","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340001","Blue Max copay 80/60 $250","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Platinum","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340001-01","Standard Platinum On Exchange Plan","88.80%","0.884273827075958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$250","$750","20%",,,,"$1,000","$3,000","$1,250","$3,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$250","$0","$1,250","$150","$250","$430","$204","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380002","Premier Blue copay 80/60 $1000A","97176LA038","7780687910","LAN001","LAS001","LAF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380002-00","Standard Gold Off Exchange Plan","79.70%","0.789866328239441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340001","Blue Max copay 80/60 $250","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Platinum","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0380002","Premier Blue copay 80/60 $1000A","97176LA038","7780687910","LAN001","LAS001","LAF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0380002-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0380002-01","Standard Gold On Exchange Plan","79.70%","0.789866328239441","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$62","$694","$150","$1,000","$630","$54","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340001","Blue Max copay 80/60 $250","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Platinum","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340001-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340001-03","Limited Cost Sharing Plan Variation","88.80%","0.884273827075958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$250","$750","20%",,,,"$1,000","$3,000","$1,250","$3,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$250","$0","$1,250","$150","$250","$430","$204","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340003","Blue Max copay 80/60 $500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340003-00","Standard Gold Off Exchange Plan","80.60%","0.798647105693817","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$20","$1,352","$150","$500","$850","$154","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340003","Blue Max copay 80/60 $500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340003-01","Standard Gold On Exchange Plan","80.60%","0.798647105693817","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$20","$1,352","$150","$500","$850","$154","$79","9"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340003","Blue Max copay 80/60 $500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340003","Blue Max copay 80/60 $500","97176LA034","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340003-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340003-03","Limited Cost Sharing Plan Variation","80.60%","0.798647105693817","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$20","$1,352","$150","$500","$850","$154","$79","11"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-03","Limited Cost Sharing Plan Variation","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-04","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","Individual","Yes","86-0257201","32753MO0840001","Anthem Dental Pediatric","32753MO084",,"MON001","MOS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212895.pdf",,,,"32753MO0840001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","5","97176","LA","Individual","No","23-7384555","97176LA0340004","Blue Max copay 80/60 $750","97176LA034","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0340004-00","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0340004-00","Standard Gold Off Exchange Plan","81.20%","0.805073976516724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$8,500","$17,000","$12,750","$25,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,302","$150","$750","$530","$104","$79","12"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360003","Group Care copay 80/60 $500","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360003-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360003-01","Standard Gold On Exchange Plan","81.30%","0.805948436260223","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","9"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360005","Group Care copay 70/50 $750A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360005-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360005-00","Standard Gold Off Exchange Plan","78.90%","0.783478081226349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","$14,250","$28,500","$750","$2,250","30%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","10"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360005","Group Care copay 70/50 $750A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360005-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360005-01","Standard Gold On Exchange Plan","78.90%","0.783478081226349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","$14,250","$28,500","$750","$2,250","30%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","11"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360006","Group Care copay 80/60 $750A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360006-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360006-00","Standard Gold Off Exchange Plan","79.30%","0.786491394042969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","$14,250","$28,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","12"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","8","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0080001","PPO - Preferred 4","32904MO008","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$24.66",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0080001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","9","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0090001","PPO - Basic 5","32904MO009","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$22.09",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0090001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","10","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0100001","PPO - Preferred 5","32904MO010","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$25.96",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0100001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","11","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0110001","PPO - Basic 6","32904MO011","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$20.07",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0110001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","12","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0120001","PPO - Preferred 6","32904MO012","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$23.89",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0120001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","13","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0130001","PPO - Basic 7","32904MO013","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$21.66",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0130001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","Individual","No","86-0257201","32753MO0770006","Anthem Bronze DirectAccess w/Child Dental - cdbr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2L","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770006-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","Individual","No","86-0257201","32753MO0770012","Anthem Gold DirectAccess w/Child Dental - cdcp","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2P","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770012-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","Individual","Yes","86-0257201","32753MO0860001","Anthem Dental Family","32753MO086",,"MON001","MOS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.66",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212893.pdf",,,,"32753MO0860001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","2","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780001","Anthem Gold Direct Access Plus-glca","32753MO078",,"MON002","MOS001","MOF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.991139537965602",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/mo","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0780001-01","Standard Gold On Exchange Plan","78.31%","0.782367944717407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$1,000","$3,000","20%",,,,"$2,000","$4,000","$3,000","$7,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770002","Anthem Bronze DirectAccess - caae","32753MO077",,"MON001","MOS001","MOF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9C","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","3","32753","MO","Individual","No","86-0257201","32753MO0770002","Anthem Bronze DirectAccess - caae","32753MO077",,"MON001","MOS001","MOF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9C","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770002-03","Limited Cost Sharing Plan Variation","60.43%","0.624035477638245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"$12,100","$24,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","4","32753","MO","Individual","No","86-0257201","32753MO0770005","Anthem Bronze DirectAccess - cabr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S9J","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770005-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","4","32753","MO","Individual","No","86-0257201","32753MO0770005","Anthem Bronze DirectAccess - cabr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S9J","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","6","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360013","Group Care copay 70/50 $2000","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360013-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360013-01","Standard Silver On Exchange Plan","71.60%","0.708419740200043","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$4,000","30%",,,,"$4,000","$12,000","$6,000","$16,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,578","$150","$2,000","$600","$126","$79","19"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360004","Group Care 80/60 $500A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360004-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360004-00","Standard Gold Off Exchange Plan","80.60%","0.806199371814728","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","4"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360004","Group Care 80/60 $500A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360004-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360004-01","Standard Gold On Exchange Plan","80.60%","0.806199371814728","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$500","$12","$2,028","$150","$500","$480","$232","$79","5"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360007","Group Care 80/60 $750A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360007-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360007-00","Standard Gold Off Exchange Plan","81.70%","0.816925823688507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","6"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360007","Group Care 80/60 $750A","97176LA036","7780687910","LAN001","LAS001","LAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360007-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360007-01","Standard Gold On Exchange Plan","81.70%","0.816925823688507","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500","$750","$2,250","20%",,,,"$1,500","$4,500","$2,250","$6,750","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$12","$1,953","$150","$750","$580","$157","$79","7"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360008","Group Care 80/60 $1000A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360008-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360008-00","Standard Gold Off Exchange Plan","79.90%","0.799314916133881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$1,000","$280","$54","$79","8"
"2014","LA","97176","HIOS","9","2014-01-21 08:29:49","7","97176","LA","SHOP (Small Group)","No","23-7384555","97176LA0360008","Group Care 80/60 $1000A","97176LA036","7780687910","LAN001","LAS001","LAF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency & non-emergency coverage subject to Blue Card Worldwide rules","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=FFM&Id=97176LA0360008-00","http://www.bcbsla.com/Employers/Pages/shop_payment_redirect.aspx","www.bcbsla.com/smallgroup-solutions-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0360008-01","Standard Gold On Exchange Plan","79.90%","0.799314916133881","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$3,000","20%",,,,"$2,000","$6,000","$3,000","$9,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$12","$1,252","$150","$1,000","$280","$54","$79","9"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010001","BEST Life Child Dental Plus","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Child_Dental_Plus_Plan.pdf",,"29416MO0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","1","29416","MO","Individual","Yes","95-6042390","29416MO0020001","BESTOne Child Dental Plus","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Child_Dental_Plus_Plan.pdf",,"29416MO0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","1","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010001","BEST Life Child Dental Plus","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Child_Dental_Plus_Plan.pdf",,"29416MO0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","1","29416","MO","Individual","Yes","95-6042390","29416MO0020001","BESTOne Child Dental Plus","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Child_Dental_Plus_Plan.pdf",,"29416MO0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010002","BEST Life Child Dental","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Child_Dental_Plan.pdf",,"29416MO0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","2","29416","MO","Individual","Yes","95-6042390","29416MO0020002","BESTOne Child Dental","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Child_Dental_Plan.pdf",,"29416MO0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","2","29416","MO","Individual","Yes","95-6042390","29416MO0020002","BESTOne Child Dental","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Child_Dental_Plan.pdf",,"29416MO0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","2","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010002","BEST Life Child Dental","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Child_Dental_Plan.pdf",,"29416MO0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","Individual","Yes","95-6042390","29416MO0020003","BESTOne Dental Advantage - Gold","29416MO002",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"29416MO0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","3","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010003","BEST Dental Advantage - Gold","29416MO001",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Advantage_Plan_(Gold).pdf",,"29416MO0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","Individual","Yes","95-6042390","29416MO0020006","BESTOne Dental Basic - Silver","29416MO002",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"29416MO0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","29416","HIOS","7","2014-01-21 08:29:49","4","29416","MO","SHOP (Small Group)","Yes","95-6042390","29416MO0010006","BEST Dental Basic - Silver","29416MO001",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MO/pdf/MO_BEST_Dental_Basic_Plan_(Silver).pdf",,"29416MO0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","30613","HIOS","5","2014-01-16 07:24:04","1","30613","MO","Individual","Yes","39-1263473","30613MO0560001","Humana Dental Smart Choice","30613MO056",,"MON001","MOS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"30613MO0560001-01","Standard Low On Exchange Plan","71.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","2","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0050001","PPO - Preferred 1","32904MO005","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$23.19",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0050001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","3","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0020001","PPO - Basic 2","32904MO002","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$18.98",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0020001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","4","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0060001","PPO - Preferred 2","32904MO006","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$22.68",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0060001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","5","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0030001","PPO - Basic 3","32904MO003","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$22.89",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0030001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","6","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0070001","PPO - Preferred 3","32904MO007","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$27.01",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0070001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","7","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0040001","PPO - Basic 4","32904MO004","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$20.60",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0040001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0150004","Bronze Deductible Only PPO HSA Eligible Plan","44527MO015",,"MON001","MOS001","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72112","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0150004","Bronze Deductible Only PPO HSA Eligible Plan","44527MO015",,"MON001","MOS001","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72112","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$16,500","$33,000","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-01","Standard Silver On Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770011","Anthem Gold DirectAccess - ccab","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770011","Anthem Gold DirectAccess - ccab","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770011-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-01","Standard Silver On Exchange Plan","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-03","Limited Cost Sharing Plan Variation","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-04","73% AV Level Silver Plan","72.75%","0.732995271682739","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","10%",,,,"$4,900","$9,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-05","87% AV Level Silver Plan","86.32%","0.865209221839905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770009","Anthem Silver DirectAccess - cbds","32753MO077",,"MON001","MOS001","MOF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9Y","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770009-06","94% AV Level Silver Plan","93.23%","0.933509588241577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$400","$800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770004","Anthem Bronze DirectAccess w/HSA - cabp","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9G","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770004-03","Limited Cost Sharing Plan Variation","61.13%","0.614655137062073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-01","Standard Silver On Exchange Plan","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-03","Limited Cost Sharing Plan Variation","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-04","73% AV Level Silver Plan","72.80%","0.731756865978241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-05","87% AV Level Silver Plan","86.17%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$2,300","$4,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"$2,300","$4,600","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770010","Anthem Silver DirectAccess w/HSA - cbbg","32753MO077",,"MON001","MOS001","MOF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0SA3","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770010-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-01","Standard Silver On Exchange Plan",,"0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-03","Limited Cost Sharing Plan Variation",,"0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","SHOP (Small Group)","Yes","86-0257201","32753MO0810001","Anthem Dental Pediatric","32753MO081",,"MON001","MOS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/mo/f0/s0/t0/pw_e212895.pdf",,,,"32753MO0810001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","1","32753","MO","SHOP (Small Group)","No","86-0257201","32753MO0780003","Anthem Bronze Direct Access Plus w/ HSA-gugb","32753MO078",,"MON002","MOS001","MOF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987473631686009",,,"0","0","0","2014-01-01",,"Yes","C","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/mo","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0780003-01","Standard Bronze On Exchange Plan","60.21%","0.611606061458588","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","4","32753","MO","Individual","No","86-0257201","32753MO0770005","Anthem Bronze DirectAccess - cabr","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S9J","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770005-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770003","Anthem Bronze DirectAccess w/HSA - caar","32753MO077",,"MON001","MOS001","MOF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9E","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770003-01","Standard Bronze On Exchange Plan",,"0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770003","Anthem Bronze DirectAccess w/HSA - caar","32753MO077",,"MON001","MOS001","MOF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9E","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770003","Anthem Bronze DirectAccess w/HSA - caar","32753MO077",,"MON001","MOS001","MOF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9E","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770003-03","Limited Cost Sharing Plan Variation",,"0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770004","Anthem Bronze DirectAccess w/HSA - cabp","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9G","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770004-01","Standard Bronze On Exchange Plan","61.13%","0.614655137062073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","5","32753","MO","Individual","No","86-0257201","32753MO0770004","Anthem Bronze DirectAccess w/HSA - cabp","32753MO077",,"MON001","MOS001","MOF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9G","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-04","73% AV Level Silver Plan",,"0.723338723182678","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-05","87% AV Level Silver Plan",,"0.86085969209671","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770007","Anthem Silver DirectAccess - cbaa","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770007-06","94% AV Level Silver Plan",,"0.932569682598114","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","6","32753","MO","Individual","No","86-0257201","32753MO0770011","Anthem Gold DirectAccess - ccab","32753MO077",,"MON001","MOS001","MOF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0T2N","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770011-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-01","Standard Silver On Exchange Plan","71.20%","0.719607710838318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-03","Limited Cost Sharing Plan Variation","71.20%","0.719607710838318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-04","73% AV Level Silver Plan","73.39%","0.736191034317017","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-05","87% AV Level Silver Plan","86.13%","0.862549245357513","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","7","32753","MO","Individual","No","86-0257201","32753MO0770008","Anthem Silver DirectAccess - cbjc","32753MO077",,"MON001","MOS001","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S9T","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770008-06","94% AV Level Silver Plan","93.08%","0.931559145450592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$1,300","$2,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"$350","$700","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MO","32753","HIOS","16","2014-03-19 07:06:49","8","32753","MO","Individual","No","86-0257201","32753MO0770013","Anthem Catastrophic DirectAccess","32753MO077",,"MON001","MOS001","MOF003","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S98","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0770013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","1","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0010001","PPO - Basic 1","32904MO001","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$19.51",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0010001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090006","Silver Integrated $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72430","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090006-06","94% AV Level Silver Plan","93.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","3","44240","MO","Individual","No","75-1296086","44240MO0090003","Bronze $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72405","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","3","44240","MO","Individual","No","75-1296086","44240MO0090003","Bronze $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72405","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","3","44240","MO","Individual","No","75-1296086","44240MO0090003","Bronze $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72405","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","4","44240","MO","Individual","No","75-1296086","44240MO0090004","Bronze Deductible Only HSA Eligible PPO Exchange","44240MO009",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72400","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","4","44240","MO","Individual","No","75-1296086","44240MO0090004","Bronze Deductible Only HSA Eligible PPO Exchange","44240MO009",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72400","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","4","44240","MO","Individual","No","75-1296086","44240MO0090004","Bronze Deductible Only HSA Eligible PPO Exchange","44240MO009",,"MON001","MOS001","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72400","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","Not Applicable","Not Applicable","40%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","Not Applicable","Not Applicable","40%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-04","73% AV Level Silver Plan","72.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","40%","Not Applicable","Not Applicable","40%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","Not Applicable","Not Applicable","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220002","Blue & U First PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF016","New","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","YES","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","YES","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","YES","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0220002-01","Standard Silver On Exchange Plan",,"0.695977568626404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$10","$1,400","$30","$200","$40","$0","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160002","Blue & U Classic PCB Gold","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160002-01","Standard Gold On Exchange Plan","78.30%","0.783190906047821","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$200","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220001","Blue & U First PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF015","New","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","YES","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","YES","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","YES","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0220001-01","Standard Gold On Exchange Plan",,"0.789387226104736","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$10","$800","$30","$200","$40","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-01","Standard Silver On Exchange Plan",,"0.683055341243744","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,500","$20","$500","$30","$2,500","$0","$40","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","1","44240","MO","Individual","No","75-1296086","44240MO0090001","Gold $5 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72408","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","1","44240","MO","Individual","No","75-1296086","44240MO0090001","Gold $5 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72408","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","2","44240","MO","Individual","No","75-1296086","44240MO0090002","Silver $10 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72414","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-05","87% AV Level Silver Plan",,"0.870086431503296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$800","$20","$400","$30","$800","$0","$70","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-06","94% AV Level Silver Plan",,"0.940562903881073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$0","$300","$30","$300","$20","$100","$40","9"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-03","Limited Cost Sharing Plan Variation","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-04","73% AV Level Silver Plan","73.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-05","87% AV Level Silver Plan","86.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,600","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","14","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0140001","PPO - Preferred 7","32904MO014","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$25.48",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0140001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","15","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0150001","PPO - Basic 8","32904MO015","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$19.76",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0150001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","16","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0160001","PPO - Preferred 8","32904MO016","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0160001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","17","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0170001","PPO - Basic 9","32904MO017","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$21.66",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0170001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","18","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0180001","PPO - Preferred 9","32904MO018","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$25.48",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0180001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","19","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0190001","PPO - Basic 10","32904MO019","7306849531","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$20.03",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0190001-00","Standard Low Off Exchange Plan","70.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$65","Not Applicable",,,,,"$65","Not Applicable","$65","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","2","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0120001","Delta Dental PPO-Exclusive - Preferred Plan","40807MO012","7497758624","MON002","MOS001",,"New","EPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$23.99",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/shop/PPO_Preferred_Plan","https://www.deltadentalmo.com/shop/PPO_Preferred_Plan_Enroll","https://www.deltadentalmo.com/shop/PPO_Preferred_Plan",,"40807MO0120001-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","3","40807","MO","Individual","Yes","43-0908349","40807MO0060001","Delta Dental Individual and Family, Premier - Basic","40807MO006","7497758624","MON001","MOS001",,"New","Indemnity","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$47.95",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/individual/Premier_Basic","https://www.deltadentalmo.com/individual/Premier_Basic_Enroll","https://www.deltadentalmo.com/individual/Premier_Basic",,"40807MO0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","3","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0130001","Delta Dental Premier - Basic Plan","40807MO013","7497758624","MON001","MOS001",,"New","Indemnity","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$26.82",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/shop/Premier_Basic_Plan","https://www.deltadentalmo.com/shop/Premier_Basic_Plan_Enroll","https://www.deltadentalmo.com/shop/Premier_Basic_Plan",,"40807MO0130001-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","4","40807","MO","Individual","Yes","43-0908349","40807MO0070001","Delta Dental Individual and Family, Premier - Preferred","40807MO007","7497758624","MON001","MOS001",,"New","Indemnity","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$58.03",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/individual/Premier_Preferred","https://www.deltadentalmo.com/individual/Premier_Preferred_Enroll","https://www.deltadentalmo.com/individual/Premier_Preferred",,"40807MO0070001-01","Standard High On Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","4","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0140001","Delta Dental Premier - Preferred Plan","40807MO014","7497758624","MON001","MOS001",,"New","Indemnity","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$32.71",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/shop/Premier_Preferred_Plan","https://www.deltadentalmo.com/shop/Premier_Preferred_Plan_Enroll","https://www.deltadentalmo.com/shop/Premier_Preferred_Plan",,"40807MO0140001-01","Standard High On Exchange Plan","85.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","5","40807","MO","Individual","Yes","43-0908349","40807MO0090001","Delta Dental Individual - Basic Pediatric PPO Plan","40807MO009","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$34.86",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0090001-00","Standard Low Off Exchange Plan","69.70%",,,,"Yes","63%","37%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","4","11324","MS","Individual","Yes","95-6042390","11324MS0020006","BESTOne Dental Basic - Silver","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"11324MS0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","4","11324","MS","Individual","Yes","95-6042390","11324MS0020006","BESTOne Dental Basic - Silver","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"11324MS0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490014-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MO","32904","HIOS","2","2013-07-01 22:22:31","20","32904","MO","SHOP (Small Group)","Yes","43-1680523","32904MO0200001","PPO - Preferred 10","32904MO020","7306849531","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Pre-existing conditions are excluded for coverage types B and C. There is a 24-month waiting period for medically necessary orthodontia coverage.",,,,,"Allows Child-Only",,,,"$23.92",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com","www.AdvanticaBenefits.com",,"32904MO0200001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220001","Blue & U First PCB Gold","34762MO022","7023011258","MON001","MOS001","MOF015","New","PPO","Gold","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","YES","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","YES","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","YES","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0220001-00","Standard Gold Off Exchange Plan",,"0.789387226104736","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$10","$800","$30","$200","$40","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160002","Blue & U Classic PCB Gold","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160002","Blue & U Classic PCB Gold","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160002-03","Limited Cost Sharing Plan Variation","78.30%","0.783190906047821","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$200","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","SHOP (Small Group)","No","43-1257251","34762MO0220002","Blue & U First PCB Silver","34762MO022","7023011258","MON001","MOS001","MOF016","New","PPO","Silver","No","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","YES","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","YES","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","YES","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0220002-00","Standard Silver Off Exchange Plan",,"0.695977568626404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$10","$1,400","$30","$200","$40","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-01","Standard Silver On Exchange Plan","68.80%","0.687625050544739","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","$300","$0","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-03","Limited Cost Sharing Plan Variation","68.80%","0.687625050544739","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","$300","$0","$40","9"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-04","73% AV Level Silver Plan","72.40%","0.723586559295654","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","10%","$3,000","$6,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$300","$0","$40","10"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-05","87% AV Level Silver Plan","86.70%","0.867249190807343","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$1,000","$2,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$700","$0","$30","$0","$200","$0","$40","11"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","1","34762","MO","Individual","No","43-1257251","34762MO0160004","Blue & U Classic PCB Silver","34762MO016","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0160004-06","94% AV Level Silver Plan","93.80%","0.938696026802063","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$12,500","$25,000","Not Applicable","Not Applicable","$250","$500","10%","$250","$500","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$400","$0","$30","$0","$100","$0","$40","12"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170002","Blue & U Classic Select Gold","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170002-01","Standard Gold On Exchange Plan","78.50%","0.784931480884552","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$200","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170002","Blue & U Classic Select Gold","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170002","Blue & U Classic Select Gold","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170002-03","Limited Cost Sharing Plan Variation","78.50%","0.784931480884552","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$200","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-01","Standard Silver On Exchange Plan","68.50%","0.684854745864868","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","$300","$0","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-03","Limited Cost Sharing Plan Variation","68.50%","0.684854745864868","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","$300","$0","$40","9"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-04","73% AV Level Silver Plan","72.30%","0.722744584083557","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","10%","$3,000","$6,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","$300","$0","$40","10"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-05","87% AV Level Silver Plan","86.10%","0.86102169752121","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$1,000","$2,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$700","$0","$30","$0","$200","$0","$40","11"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","2","34762","MO","Individual","No","43-1257251","34762MO0170004","Blue & U Classic Select Silver","34762MO017","7023011258","MON002","MOS002","MOF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0170004-06","94% AV Level Silver Plan","93.60%","0.935858845710754","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$12,500","$25,000","Not Applicable","Not Applicable","$250","$500","10%","$250","$500","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$400","$0","$30","$0","$100","$0","$40","12"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150002","Blue & U First Select Gold","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150002-01","Standard Gold On Exchange Plan","80.60%","0.780943930149078","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,700","$5,400","$2,700","$5,400","$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%","$2,700","$5,400","0%","$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","$40","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150002","Blue & U First Select Gold","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150002","Blue & U First Select Gold","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150002-03","Limited Cost Sharing Plan Variation","80.60%","0.780943930149078","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,700","$5,400","$2,700","$5,400","$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%","$2,700","$5,400","0%","$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","$40","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-01","Standard Silver On Exchange Plan","69.40%","0.692758202552795","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$4,750","$9,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%","$4,750","$9,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","$40","$0","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-03","Limited Cost Sharing Plan Variation","69.40%","0.692758202552795","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$4,750","$9,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%","$4,750","$9,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","$40","$0","$40","9"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-04","73% AV Level Silver Plan","72.80%","0.726763725280762","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,750","$7,500","$3,750","$7,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","0%","$3,750","$7,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$3,750","$0","$0","$30","$200","$40","$0","$40","10"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-05","87% AV Level Silver Plan","86.20%","0.862267374992371","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%","$1,500","$3,000","0%","$4,750","$9,500","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$100","$40","$0","$40","11"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","3","34762","MO","Individual","No","43-1257251","34762MO0150004","Blue & U First Select Silver","34762MO015","7023011258","MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150004-06","94% AV Level Silver Plan","93.50%","0.93478786945343","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%","$600","$1,200","0%","$4,750","$9,500","Not Applicable","Not Applicable","$600","$0","$0","$30","$200","$40","$0","$40","12"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0140006","Blue & U First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140006-01","Standard Bronze On Exchange Plan","61.10%","0.611002326011658","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0140006","Blue & U First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0140006","Blue & U First PCB Bronze","34762MO014","7023011258","MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140006-03","Limited Cost Sharing Plan Variation","61.10%","0.611002326011658","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0150006","Blue & U First Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150006-01","Standard Bronze On Exchange Plan","61.10%","0.611002326011658","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","10%",,,,"$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0150006","Blue & U First Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","4","34762","MO","Individual","No","43-1257251","34762MO0150006","Blue & U First Select Bronze","34762MO015","7023011258","MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0150006-03","Limited Cost Sharing Plan Variation","61.10%","0.611002326011658","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","10%",,,,"$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","9"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-03","Limited Cost Sharing Plan Variation",,"0.683055341243744","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,500","$20","$500","$30","$2,500","$0","$40","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","5","34762","MO","Individual","No","43-1257251","34762MO0180003","Blue & U Saver PCB Silver","34762MO018","7023011258","MON001","MOS001","MOF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0180003-04","73% AV Level Silver Plan",,"0.722182929515839","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,125","$6,250",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,000","$20","$500","$30","$2,000","$0","$40","$40","7"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140002","Blue & U First PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140002-01","Standard Gold On Exchange Plan","78.70%","0.788814067840576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","$40","$0","$40","4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140002","Blue & U First PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140002","Blue & U First PCB Gold","34762MO014","7023011258","MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140002-03","Limited Cost Sharing Plan Variation","78.70%","0.788814067840576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","$40","$0","$40","6"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-01","Standard Silver On Exchange Plan","68.40%","0.689968287944794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","$40","$0","$40","7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0160003","Bronze $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0150004","Bronze Deductible Only PPO HSA Eligible Plan","44527MO015",,"MON001","MOS001","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72112","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090008","Silver $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72426","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-01","Standard Silver On Exchange Plan","68.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","1","46300","MS","Individual","Yes","72-0977315","46300MS0010001","AlwaysCare AllStar Kids Dental Plan","46300MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0010001-00","Standard High Off Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","1","46300","MS","Individual","Yes","72-0977315","46300MS0010001","AlwaysCare AllStar Kids Dental Plan","46300MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0010001-01","Standard High On Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","1","46300","MS","Individual","Yes","72-0977315","46300MS0010002","AlwaysCare AllStar Kids Dental Plan","46300MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0010002-00","Standard Low Off Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana National Preferred Bronze 6300/6300 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104778","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096952","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana National Preferred Bronze 6300/6300 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104778","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096952","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500008-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-00","Standard Silver Off Exchange Plan",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-01","Standard Silver On Exchange Plan",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-04","73% AV Level Silver Plan",,"0.738342940807343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,220","$30","$1,270","$150","$2,000","$870","$220","$80","13"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-05","87% AV Level Silver Plan",,"0.877610564231873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$20","$1,010","$150","$350","$550","$230","$80","14"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-06","94% AV Level Silver Plan",,"0.947545647621155","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$75","$150","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$250","$150","$130","$100","$70","$80","15"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage Platinum 500","11512NC006",,"NCN001","NCS001","NCF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060017-00","Standard Platinum Off Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-03","Limited Cost Sharing Plan Variation","68.40%","0.689968287944794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","$40","$0","$40","9"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-04","73% AV Level Silver Plan","73.30%","0.732715845108032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","$3,750","$0","$0","$30","$200","$40","$0","$40","10"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-05","87% AV Level Silver Plan","86.40%","0.863930761814117","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$200","$40","$0","$40","11"
"2014","MO","34762","HIOS","6","2014-01-16 07:24:04","6","34762","MO","Individual","No","43-1257251","34762MO0140004","Blue & U First PCB Silver","34762MO014","7023011258","MON001","MOS001","MOF017","New","PPO","Silver","Yes","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/ Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If you receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will receive the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","34762MO0140004-06","94% AV Level Silver Plan","93.50%","0.935293614864349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","$600","$0","$0","$30","$200","$40","$0","$40","12"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","1","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0020001","Managed DentalGuard MO Child Essentials 1","39371MO002",,"MON001","MOS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0020001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","1","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0020001","Managed DentalGuard MO Child Essentials 1","39371MO002",,"MON001","MOS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0020001-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","1","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0010001","Managed DentalGuard MO Child Essentials 2","39371MO001",,"MON001","MOS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0010001-00","Standard High Off Exchange Plan","83.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","1","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0010001","Managed DentalGuard MO Child Essentials 2","39371MO001",,"MON001","MOS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0010001-01","Standard High On Exchange Plan","83.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","2","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0030001","Managed DentalGuard MO 10 Family Plan","39371MO003",,"MON001","MOS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0030001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","2","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0030001","Managed DentalGuard MO 10 Family Plan","39371MO003",,"MON001","MOS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0030001-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","2","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0040001","Managed DentalGuard MO 20 Family Plan","39371MO004",,"MON001","MOS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0040001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","39371","HIOS","5","2013-09-11 07:49:18","2","39371","MO","SHOP (Small Group)","Yes","43-1501438","39371MO0050001","Managed DentalGuard MO 30 Family Plan","39371MO005",,"MON001","MOS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"39371MO0050001-00","Standard Low Off Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","1","40807","MO","Individual","Yes","43-0908349","40807MO0040001","Delta Dental Individual and Family, PPO-Exclusive - Basic","40807MO004","7497758624","MON002","MOS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$35.66",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/individual/PPO_Basic","https://www.deltadentalmo.com/individual/PPO_Basic_Enroll","https://www.deltadentalmo.com/individual/PPO_Basic",,"40807MO0040001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","1","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0110001","Delta Dental PPO-Exclusive - Basic Plan","40807MO011","7497758624","MON002","MOS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$19.75",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/shop/PPO_Basic_Plan","https://www.deltadentalmo.com/shop/PPO_Basic_Plan_Enroll","https://www.deltadentalmo.com/shop/PPO_Basic_Plan",,"40807MO0110001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","2","40807","MO","Individual","Yes","43-0908349","40807MO0050001","Delta Dental Individual and Family, PPO-Exclusive - Preferred","40807MO005","7497758624","MON002","MOS001",,"New","EPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$43.59",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalmo.com/individual/PPO_Preferred","https://www.deltadentalmo.com/individual/PPO_Preferred_Enroll","https://www.deltadentalmo.com/individual/PPO_Preferred",,"40807MO0050001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","5","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0150001","Delta Dental PPO - Basic Pediatric 1","40807MO015","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$21.04",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0150001-00","Standard Low Off Exchange Plan","71.60%",,,,"Yes","45%","55%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","6","40807","MO","Individual","Yes","43-0908349","40807MO0100001","Delta Dental Individual - Preferred Pediatric PPO Plan","40807MO010","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$42.40",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0100001-00","Standard High Off Exchange Plan","83.30%",,,,"Yes","67%","33%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$0","Not Applicable",,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","6","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0160001","Delta Dental PPO - Basic Pediatric 2","40807MO016","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$20.16",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0160001-00","Standard Low Off Exchange Plan","69.80%",,,,"Yes","51%","49%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","7","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0170001","Delta Dental PPO - Basic Pediatric 3","40807MO017","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$20.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0170001-00","Standard Low Off Exchange Plan","69.50%",,,,"Yes","51%","49%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","8","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0180001","Delta Dental PPO - Basic Pediatric 4","40807MO018","7497758624","MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$20.50",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0180001-00","Standard Low Off Exchange Plan","71.00%",,,,"Yes","51%","49%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","9","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0190001","Delta Dental PPO - Preferred Pediatric 1","40807MO019","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$24.96",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0190001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","45%","55%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","10","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0200001","Delta Dental PPO - Preferred Pediatric 2","40807MO020","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$24.62",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0200001-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","51%","49%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","11","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0210001","Delta Dental PPO - Preferred Pediatric 3","40807MO021","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$24.41",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0210001-00","Standard High Off Exchange Plan","83.90%",,,,"Yes","49%","51%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","40807","HIOS","6","2013-11-26 13:14:08","12","40807","MO","SHOP (Small Group)","Yes","43-0908349","40807MO0220001","Delta Dental PPO - Preferred Pediatric 4","40807MO022","7497758624","MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$24.62",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalmo.com","www.deltadentalmo.com","www.deltadentalmo.com",,"40807MO0220001-00","Standard High Off Exchange Plan","85.10%",,,,"Yes","51%","49%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$25","Not Applicable",,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","1","44240","MO","Individual","No","75-1296086","44240MO0090001","Gold $5 Copay PPO Exchange","44240MO009",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72408","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Bronze $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72110","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Bronze $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72110","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150003-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0160003","Bronze $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0160003","Bronze $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-03","Limited Cost Sharing Plan Variation","68.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","3","60328","MS","Individual","Yes","75-1233841","60328MS0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","60328MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010004",,"60328MS0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010002","Ambetter Gold 2","94237MS001",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997421731340853",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010002","Ambetter Gold 2","94237MS001",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997421731340853",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010002","Ambetter Gold 2","94237MS001",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997421731340853",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","MO","86182","HIOS","1","2013-06-06 10:50:48","1","86182","MO","SHOP (Small Group)","Yes","93-0242990","86182MO0030002","EHB High Passive","86182MO003",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86182MO0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","86182","HIOS","1","2013-06-06 10:50:48","1","86182","MO","SHOP (Small Group)","Yes","93-0242990","86182MO0030001","EHB Low Passive","86182MO003",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.72",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86182MO0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","1","11324","MS","Individual","Yes","95-6042390","11324MS0020001","BESTOne Child Dental Plus","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Child_Dental_Plus_Plan.pdf",,"11324MS0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","1","11324","MS","Individual","Yes","95-6042390","11324MS0020001","BESTOne Child Dental Plus","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Child_Dental_Plus_Plan.pdf",,"11324MS0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","2","11324","MS","Individual","Yes","95-6042390","11324MS0020002","BESTOne Child Dental","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Child_Dental_Plan.pdf",,"11324MS0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","2","11324","MS","Individual","Yes","95-6042390","11324MS0020002","BESTOne Child Dental","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Child_Dental_Plan.pdf",,"11324MS0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","3","11324","MS","Individual","Yes","95-6042390","11324MS0020003","BESTOne Dental Advantage - Gold","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"11324MS0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","3","11324","MS","Individual","Yes","95-6042390","11324MS0020003","BESTOne Dental Advantage - Gold","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"11324MS0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","3","11324","MS","Individual","Yes","95-6042390","11324MS0020004","BESTOne Dental Plus - Gold","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"11324MS0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490011","Humana Local Preferred Basic 6350/6350 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104700","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059226","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490011","Humana Local Preferred Basic 6350/6350 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104700","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059226","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010012","Ambetter Bronze 3","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010012","Ambetter Bronze 3","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010012","Ambetter Bronze 3","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010013","Ambetter Bronze 4","94237MS001",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997541723396132",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010013","Ambetter Bronze 4","94237MS001",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997541723396132",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010013","Ambetter Bronze 4","94237MS001",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997541723396132",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-01","Standard Silver On Exchange Plan",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","10"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-03","Limited Cost Sharing Plan Variation",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","12"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-04","73% AV Level Silver Plan","72.10%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,000","$10,000","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-05","87% AV Level Silver Plan","86.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","6","44240","MO","Individual","No","75-1296086","44240MO0090012","Silver Integrated $10 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72435","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090012-06","94% AV Level Silver Plan","93.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","7","44240","MO","Individual","No","75-1296086","44240MO0090009","Bronze $15 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72417","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090009-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","7","44240","MO","Individual","No","75-1296086","44240MO0090009","Bronze $15 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72417","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090009-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","7","44240","MO","Individual","No","75-1296086","44240MO0090009","Bronze $15 Copay PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72417","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo3-tier","www.c1formularyhix.com","44240MO0090009-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","8","44240","MO","Individual","No","75-1296086","44240MO0090010","Bronze Deductible Only HSA Eligible PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72445","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090010-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","8","44240","MO","Individual","No","75-1296086","44240MO0090010","Bronze Deductible Only HSA Eligible PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72445","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","8","44240","MO","Individual","No","75-1296086","44240MO0090010","Bronze Deductible Only HSA Eligible PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72445","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090010-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","44240","HIOS","8","2013-11-26 13:14:08","8","44240","MO","Individual","No","75-1296086","44240MO0090011","Catastrophic 100% PPO KC Exchange","44240MO009",,"MON001","MOS002","MOF006","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/mo72448","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoksmo","www.c1formularyhix.com","44240MO0090011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0150001","Gold $10 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0150001","Gold $10 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0150001","Gold $10 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0160001","Gold $5 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72115","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0160001","Gold $5 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72115","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","1","44527","MO","Individual","No","75-1296086","44527MO0160001","Gold $5 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF001","New","PPO","Gold","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72115","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0150002","Silver $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72103","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150002-01","Standard Silver On Exchange Plan","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,800","$25,600","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","2","44527","MO","Individual","No","75-1296086","44527MO0160002","Silver $10 Copay PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF002","New","PPO","Silver","Yes","On the Exchange","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both elective and emergent","Yes","Both elective and emergent","No","http://coventryhealthcare.com/MO72118","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","3","44527","MO","Individual","No","75-1296086","44527MO0150003","Bronze $15 Copay PPO Plan","44527MO015",,"MON001","MOS001","MOF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72110","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150003-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0160004","Bronze Deductible Only PPO HSA Eligible Carelink fromCoventry","44527MO016",,"MON002","MOS002","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72127","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0160004","Bronze Deductible Only PPO HSA Eligible Carelink fromCoventry","44527MO016",,"MON002","MOS002","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72127","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","4","44527","MO","Individual","No","75-1296086","44527MO0160004","Bronze Deductible Only PPO HSA Eligible Carelink fromCoventry","44527MO016",,"MON002","MOS002","MOF006","New","PPO","Bronze","No","On the Exchange","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72127","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","5","44527","MO","Individual","No","75-1296086","44527MO0150005","Catastrophic 100% PPO Plan","44527MO015",,"MON001","MOS001","MOF007","New","PPO","Catastrophic","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72114","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://www.c1formularyhix.com","44527MO0150005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","44527","HIOS","7","2014-01-21 08:29:49","5","44527","MO","Individual","No","75-1296086","44527MO0160005","Catastrophic 100% PPO Carelink from Coventry","44527MO016",,"MON002","MOS002","MOF007","New","PPO","Catastrophic","No","On the Exchange","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/MO72129","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://www.c1formularyhix.com","44527MO0160005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","48616","HIOS","1","2013-06-04 08:25:28","1","48616","MO","SHOP (Small Group)","Yes","47-0098400","48616MO0030002","EHB High Passive","48616MO003",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.72",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48616MO0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-03","Limited Cost Sharing Plan Variation",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-04","73% AV Level Silver Plan",,"0.721818149089813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana National Preferred  Gold 2500/3500 Plan","48963MS050",,"MSN004","MSS004","MSF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104830","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097199","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500012-00","Standard Gold Off Exchange Plan","78.07%","0.780732274055481","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana National Preferred  Gold 2500/3500 Plan","48963MS050",,"MSN004","MSS004","MSF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104830","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097199","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500012-01","Standard Gold On Exchange Plan","78.07%","0.780732274055481","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana National Preferred  Gold 2500/3500 Plan","48963MS050",,"MSN004","MSS004","MSF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104830","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097199","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500012","Humana National Preferred  Gold 2500/3500 Plan","48963MS050",,"MSN004","MSS004","MSF007","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104830","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097199","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500012-03","Limited Cost Sharing Plan Variation","78.07%","0.780732274055481","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","MO","48616","HIOS","1","2013-06-04 08:25:28","1","48616","MO","SHOP (Small Group)","Yes","47-0098400","48616MO0030001","EHB Low Passive","48616MO003",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.28",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48616MO0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0090001","Guardian Pediatric Advantage","48786MO009",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0090001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0090001","Guardian Pediatric Advantage","48786MO009",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0090001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0100001","Guardian Pediatric Essentials","48786MO010",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0100001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","1","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0100001","Guardian Pediatric Essentials","48786MO010",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0100001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","2","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0110001","Guardian Family Advantage Plus","48786MO011",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0110001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","2","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0110001","Guardian Family Advantage Plus","48786MO011",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0110001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0130001","Guardian Family Essentials Plus","48786MO013",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0130001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","3","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0130001","Guardian Family Essentials Plus","48786MO013",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0130001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","4","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0120001","Guardian Family Advantage","48786MO012",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0120001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","4","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0120001","Guardian Family Advantage","48786MO012",,"MON001","MOS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0120001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","4","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0140001","Guardian Family Essentials","48786MO014",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MO","48786","HIOS","5","2013-09-02 11:39:25","4","48786","MO","SHOP (Small Group)","Yes","13-5123390","48786MO0140001","Guardian Family Essentials","48786MO014",,"MON001","MOS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"48786MO0140001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MO","59976","HIOS","1","2013-06-06 10:50:48","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010001","DentalConnect�","59976MO001",,"MON001","MOS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"59976MO0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","59976","HIOS","1","2013-06-06 10:50:48","1","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010002","DentalConnect�","59976MO001",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"59976MO0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","59976","HIOS","1","2013-06-06 10:50:48","2","59976","MO","SHOP (Small Group)","Yes","35-0472300","59976MO0010003","DentalConnect�","59976MO001",,"MON001","MOS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"59976MO0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","68396","HIOS","7","2013-10-15 07:27:56","1","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON003","MOS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$14.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044",,"68396MO0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","68396","HIOS","7","2013-10-15 07:27:56","1","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0190001","Family Basic Dental Plan (Low)","68396MO019",,"MON003","MOS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$14.93",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48045",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48044",,"68396MO0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MO","68396","HIOS","7","2013-10-15 07:27:56","2","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON004","MOS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093",,"68396MO0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MO","68396","HIOS","7","2013-10-15 07:27:56","2","68396","MO","SHOP (Small Group)","Yes","13-5581829","68396MO0200001","Family Enhanced Dental Plan (High)","68396MO020",,"MON004","MOS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49094",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49093",,"68396MO0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","3","11324","MS","Individual","Yes","95-6042390","11324MS0020004","BESTOne Dental Plus - Gold","11324MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"11324MS0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","4","11324","MS","Individual","Yes","95-6042390","11324MS0020005","BESTOne Dental Plus - Silver","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"11324MS0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","11324","HIOS","8","2014-01-21 08:29:49","4","11324","MS","Individual","Yes","95-6042390","11324MS0020005","BESTOne Dental Plus - Silver","11324MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MS/pdf/MS_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"11324MS0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490012-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-06","94% AV Level Silver Plan",,"0.947545647621155","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$75","$150","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$250","$150","$130","$100","$70","$80","15"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020002","Ambetter Gold 2 + Vision","94237MS002",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983260491071695",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020002","Ambetter Gold 2 + Vision","94237MS002",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983260491071695",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020002","Ambetter Gold 2 + Vision","94237MS002",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983260491071695",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","4","94237","MS","Individual","No","20-8570212","94237MS0020009","Ambetter Silver 5 + Vision","94237MS002",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983151511022991",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020004","Ambetter Gold 4 + Vision","94237MS002",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020004","Ambetter Gold 4 + Vision","94237MS002",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490012-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490012","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN001","MSS001","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490012-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490001","Humana Local Preferred Basic 6350/6350 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104700","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059226","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490001","Humana Local Preferred Basic 6350/6350 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104700","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059226","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490015-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490003","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN002","MSS002","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490003-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","1","46300","MS","Individual","Yes","72-0977315","46300MS0010002","AlwaysCare AllStar Kids Dental Plan","46300MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0010002-01","Standard Low On Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","2","46300","MS","Individual","Yes","72-0977315","46300MS0020001","AlwaysCare AllStar Family Dental Plan","46300MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0020001-00","Standard High Off Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","2","46300","MS","Individual","Yes","72-0977315","46300MS0020001","AlwaysCare AllStar Family Dental Plan","46300MS002",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0020001-01","Standard High On Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","2","46300","MS","Individual","Yes","72-0977315","46300MS0020002","AlwaysCare AllStar Family Dental Plan","46300MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0020002-00","Standard Low Off Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","46300","HIOS","4","2014-01-21 08:29:49","2","46300","MS","Individual","Yes","72-0977315","46300MS0020002","AlwaysCare AllStar Family Dental Plan","46300MS002",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"46300MS0020002-01","Standard Low On Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","Yes","39-1263473","48963MS0510001","Humana Dental Smart Choice","48963MS051",,"MSN003","MSS003",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.06",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084368",,"48963MS0510001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490013","Humana Local Preferred Silver 4600/6300 Plan","48963MS049",,"MSN001","MSS001","MSF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104726","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059265","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490013-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490014-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490014","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490014-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490015-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490015-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490015","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN001","MSS001","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490004-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490004","Humana Local Preferred Gold 2500/3500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104739","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059291","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490005-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","1","48963","MS","Individual","No","39-1263473","48963MS0490005","Humana Local Preferred Platinum 1000/1500 Plan","48963MS049",,"MSN002","MSS002","MSF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104752","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059317","http://apps.humana.com/marketing/documents.asp?file=2067403","48963MS0490005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","2","48963","MS","Individual","No","39-1263473","48963MS0490002","Humana Local Preferred Bronze 6300/6300 Plan","48963MS049",,"MSN002","MSS002","MSF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104713","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059239","http://apps.humana.com/marketing/documents.asp?file=2067338","48963MS0490002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-00","Standard Silver Off Exchange Plan","69.53%","0.695273876190186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-01","Standard Silver On Exchange Plan","69.53%","0.695273876190186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-03","Limited Cost Sharing Plan Variation","69.53%","0.695273876190186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-04","73% AV Level Silver Plan","73.51%","0.735092222690582","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-05","87% AV Level Silver Plan","86.76%","0.867647707462311","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","3","48963","MS","Individual","No","39-1263473","48963MS0500010","Humana National Preferred Silver 4250/6250 Plan","48963MS050",,"MSN004","MSS004","MSF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104804","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097004","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500010-06","94% AV Level Silver Plan","93.69%","0.93690437078476","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$250","$500","50%",,,,"$750","$1,500","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500007","Humana National Preferred Basic 6350/6350 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104765","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096926","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500007","Humana National Preferred Basic 6350/6350 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104765","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096926","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana National Preferred Bronze 6300/6300 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104778","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096952","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500008-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500008","Humana National Preferred Bronze 6300/6300 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104778","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096952","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500008-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010004","Ambetter Gold 4","94237MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010004","Ambetter Gold 4","94237MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","2","94237","MS","Individual","No","20-8570212","94237MS0010004","Ambetter Gold 4","94237MS001",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997445624310735",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","4","48963","MS","Individual","No","39-1263473","48963MS0500011","Humana National Preferred Silver 3650/3650 Plan","48963MS050",,"MSN004","MSS004","MSF004","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104817","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2097134","http://apps.humana.com/marketing/documents.asp?file=2073097","48963MS0500011-06","94% AV Level Silver Plan",,"0.935785233974457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$475","$950",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$475","$950","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","5","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana National Preferred Bronze 4850/6350 Plan","48963MS050",,"MSN004","MSS004","MSF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104791","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096965","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500009-00","Standard Bronze Off Exchange Plan","61.69%","0.616929411888123","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","5","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana National Preferred Bronze 4850/6350 Plan","48963MS050",,"MSN004","MSS004","MSF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104791","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096965","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500009-01","Standard Bronze On Exchange Plan","61.69%","0.616929411888123","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","5","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana National Preferred Bronze 4850/6350 Plan","48963MS050",,"MSN004","MSS004","MSF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104791","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096965","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MS","48963","HIOS","10","2014-03-19 07:06:49","5","48963","MS","Individual","No","39-1263473","48963MS0500009","Humana National Preferred Bronze 4850/6350 Plan","48963MS050",,"MSN004","MSS004","MSF005","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104791","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2096965","http://apps.humana.com/marketing/documents.asp?file=2073084","48963MS0500009-03","Limited Cost Sharing Plan Variation","61.69%","0.616929411888123","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","1","49374","MS","Individual","Yes","94-2761537","49374MS0010001","Delta Dental PPO Plan 70 for Children","49374MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.86",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010001",,"49374MS0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","1","49374","MS","Individual","Yes","94-2761537","49374MS0010001","Delta Dental PPO Plan 70 for Children","49374MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.86",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010001",,"49374MS0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","1","49374","MS","Individual","Yes","94-2761537","49374MS0010002","Delta Dental PPO Plan 85 for Children","49374MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010002",,"49374MS0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","1","49374","MS","Individual","Yes","94-2761537","49374MS0010002","Delta Dental PPO Plan 85 for Children","49374MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010002",,"49374MS0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","2","49374","MS","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","49374MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.86",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010006",,"49374MS0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","2","49374","MS","Individual","Yes","94-2761537","49374MS0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","49374MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.86",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010006",,"49374MS0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","3","49374","MS","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","49374MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010004",,"49374MS0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","49374","HIOS","8","2014-01-21 08:29:49","3","49374","MS","Individual","Yes","94-2761537","49374MS0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","49374MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/ms/49374ms0010004",,"49374MS0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","1","60328","MS","Individual","Yes","75-1233841","60328MS0010001","Dentegra Dental PPO Children's Plan 70","60328MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010001",,"60328MS0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","1","60328","MS","Individual","Yes","75-1233841","60328MS0010001","Dentegra Dental PPO Children's Plan 70","60328MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010001",,"60328MS0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","1","60328","MS","Individual","Yes","75-1233841","60328MS0010002","Dentegra Dental PPO Children's Plan 85","60328MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010002",,"60328MS0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","1","60328","MS","Individual","Yes","75-1233841","60328MS0010002","Dentegra Dental PPO Children's Plan 85","60328MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010002",,"60328MS0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","2","60328","MS","Individual","Yes","75-1233841","60328MS0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","60328MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010006",,"60328MS0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","2","60328","MS","Individual","Yes","75-1233841","60328MS0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","60328MS001",,"MSN001","MSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010006",,"60328MS0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MS","60328","HIOS","8","2014-01-17 09:36:20","3","60328","MS","Individual","Yes","75-1233841","60328MS0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","60328MS001",,"MSN001","MSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ms/60328ms0010004",,"60328MS0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","1","94237","MS","Individual","No","20-8570212","94237MS0010009","Ambetter Silver 5","94237MS001",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997311183484984",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-04","73% AV Level Silver Plan",,"0.738342940807343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,220","$30","$1,270","$150","$2,000","$870","$220","$80","13"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","3","94237","MS","Individual","No","20-8570212","94237MS0010014","Ambetter Silver 6","94237MS001",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997560290650177",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0010014-05","87% AV Level Silver Plan",,"0.877610564231873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$20","$1,010","$150","$350","$550","$230","$80","14"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020004","Ambetter Gold 4 + Vision","94237MS002",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020012","Ambetter Bronze 3 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020012","Ambetter Bronze 3 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020012","Ambetter Bronze 3 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983284045187703",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020013","Ambetter Bronze 4 + Vision","94237MS002",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983378781380682",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020013","Ambetter Bronze 4 + Vision","94237MS002",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983378781380682",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","5","94237","MS","Individual","No","20-8570212","94237MS0020013","Ambetter Bronze 4 + Vision","94237MS002",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983378781380682",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-01","Standard Silver On Exchange Plan",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","10"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-03","Limited Cost Sharing Plan Variation",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","12"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-04","73% AV Level Silver Plan",,"0.738342940807343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,220","$30","$1,270","$150","$2,000","$870","$220","$80","13"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-05","87% AV Level Silver Plan",,"0.877610564231873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$20","$1,010","$150","$350","$550","$230","$80","14"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","6","94237","MS","Individual","No","20-8570212","94237MS0020014","Ambetter Silver 6 + Vision","94237MS002",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983397085310995",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0020014-06","94% AV Level Silver Plan",,"0.947545647621155","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$75","$150","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$250","$150","$130","$100","$70","$80","15"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030002","Ambetter Gold 2 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947361934621931",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030002","Ambetter Gold 2 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947361934621931",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030002","Ambetter Gold 2 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947361934621931",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","7","94237","MS","Individual","No","20-8570212","94237MS0030009","Ambetter Silver 5 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947256933929246",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030004","Ambetter Gold 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030004","Ambetter Gold 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030004","Ambetter Gold 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030012","Ambetter Bronze 3 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030012","Ambetter Bronze 3 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030012","Ambetter Bronze 3 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947384628670298",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030013","Ambetter Bronze 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947475905615054",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030013","Ambetter Bronze 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947475905615054",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","8","94237","MS","Individual","No","20-8570212","94237MS0030013","Ambetter Bronze 4 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947475905615054",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-01","Standard Silver On Exchange Plan",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","10"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","MS","94237","HIOS","4","2013-08-30 07:44:10","9","94237","MS","Individual","No","20-8570212","94237MS0030014","Ambetter Silver 6 + Vision + Adult Dental","94237MS003",,"MSN001","MSS001","MSF011","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.947493541185827",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.magnoliahealthplan.com/benefits","http://ambetter.magnoliahealthplan.com/payments","http://ambetter.magnoliahealthplan.com/ourplans","http://ambetter.magnoliahealthplan.com/formulary","94237MS0030014-03","Limited Cost Sharing Plan Variation",,"0.718193292617798","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$30","$1,270","$150","$2,300","$870","$150","$80","12"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020003","Blue Options Platinum 500-1","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Platinum_500.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020003-00","Standard Platinum Off Exchange Plan","88.12%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020003","Blue Options Platinum 500-1","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Platinum_500.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020003-01","Standard Platinum On Exchange Plan","88.12%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage Platinum 500","11512NC006",,"NCN001","NCS001","NCF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060017-01","Standard Platinum On Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020005","Blue Options Gold 1750-2","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Gold_1750.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020005-00","Standard Gold Off Exchange Plan","80.23%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage Platinum 500","11512NC006",,"NCN001","NCS001","NCF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020005","Blue Options Gold 1750-2","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Gold_1750.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020005-01","Standard Gold On Exchange Plan","80.23%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060017","Blue Advantage Platinum 500","11512NC006",,"NCN001","NCS001","NCF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060017-03","Limited Cost Sharing Plan Variation","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020007","Blue Options Gold 1500-3","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Gold_1500.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020007-00","Standard Gold Off Exchange Plan","80.27%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage Gold 1000","11512NC006",,"NCN001","NCS001","NCF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060018-00","Standard Gold Off Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020007","Blue Options Gold 1500-3","11512NC002",,"NCN001","NCS001","NCF017","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Gold_1500.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020007-01","Standard Gold On Exchange Plan","80.27%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage Gold 1000","11512NC006",,"NCN001","NCS001","NCF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060018-01","Standard Gold On Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020014","Blue Options Silver 2000-6","11512NC002",,"NCN001","NCS001","NCF019","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020014-00","Standard Silver Off Exchange Plan","71.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage Gold 1000","11512NC006",,"NCN001","NCS001","NCF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060018","Blue Advantage Gold 1000","11512NC006",,"NCN001","NCS001","NCF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060018-03","Limited Cost Sharing Plan Variation","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0020014","Blue Options Silver 2000-6","11512NC002",,"NCN001","NCS001","NCF019","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0020014-01","Standard Silver On Exchange Plan","71.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"12"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"13"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-03","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"15"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-04","73% AV Level Silver Plan","73.94%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$9,800","$19,600","$14,700","$29,400","$2,700","$5,400","30%",,,,"$5,400","$10,800","$8,100","$16,200","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"16"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-05","87% AV Level Silver Plan","86.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"17"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060019","Blue Advantage Silver 2800","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060019-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"18"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"19"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"20"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-03","Limited Cost Sharing Plan Variation","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"22"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"23"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-05","87% AV Level Silver Plan","86.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$5,700","$11,400","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"24"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060020","Blue Advantage Silver 3500","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060020-06","94% AV Level Silver Plan","93.67%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"25"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-00","Standard Silver Off Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"26"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-01","Standard Silver On Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"27"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-03","Limited Cost Sharing Plan Variation","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"29"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"30"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-05","87% AV Level Silver Plan","86.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"31"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0060021","Blue Advantage Silver 5000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060021-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"32"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value Platinum 500","11512NC010",,"NCN002","NCS002","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100021-00","Standard Platinum Off Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"33"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value Platinum 500","11512NC010",,"NCN002","NCS002","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100021-01","Standard Platinum On Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"34"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value Platinum 500","11512NC010",,"NCN002","NCS002","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"35"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100021","Blue Value Platinum 500","11512NC010",,"NCN002","NCS002","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100021-03","Limited Cost Sharing Plan Variation","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"36"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value Gold 1000","11512NC010",,"NCN002","NCS002","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100022-00","Standard Gold Off Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"37"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value Gold 1000","11512NC010",,"NCN002","NCS002","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100022-01","Standard Gold On Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"38"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value Gold 1000","11512NC010",,"NCN002","NCS002","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100022-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100022","Blue Value Gold 1000","11512NC010",,"NCN002","NCS002","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100022-03","Limited Cost Sharing Plan Variation","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"40"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"41"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"42"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-03","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"44"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-04","73% AV Level Silver Plan","73.94%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$9,800","$19,600","$14,700","$29,400","$2,700","$5,400","30%",,,,"$5,400","$10,800","$8,100","$16,200","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"45"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-05","87% AV Level Silver Plan","86.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"46"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100023","Blue Value Silver 2800","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100023-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"47"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"48"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"49"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"50"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-03","Limited Cost Sharing Plan Variation","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"51"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"52"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-05","87% AV Level Silver Plan","86.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$5,700","$11,400","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"53"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100024","Blue Value Silver 3500","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100024-06","94% AV Level Silver Plan","93.67%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"54"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-00","Standard Silver Off Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"55"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-01","Standard Silver On Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"56"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"57"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-03","Limited Cost Sharing Plan Variation","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"58"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"59"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-05","87% AV Level Silver Plan","86.74%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"60"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100025","Blue Value Silver 5000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100025-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"61"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select Gold 1000","11512NC012",,"NCN001","NCS004","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120001-00","Standard Gold Off Exchange Plan","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"62"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select Gold 1000","11512NC012",,"NCN001","NCS004","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120001-01","Standard Gold On Exchange Plan","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"63"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select Gold 1000","11512NC012",,"NCN001","NCS004","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"64"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120001","Blue Select Gold 1000","11512NC012",,"NCN001","NCS004","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120001-03","Limited Cost Sharing Plan Variation","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"65"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"66"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"67"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"68"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-03","Limited Cost Sharing Plan Variation","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"69"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-04","73% AV Level Silver Plan","73.98%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"70"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-05","87% AV Level Silver Plan","86.74%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$1,900","$3,800","$1,900","$3,800","$3,800","$7,600","$5,700","$11,400","$1,000","$2,000","30%","$1,000","$2,000","50%","$2,000","$4,000","$3,000","$6,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"71"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120002","Blue Select Silver 3500","11512NC012",,"NCN001","NCS004","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120002-06","94% AV Level Silver Plan","93.77%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$700","$1,400","$700","$1,400","$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%","$500","$1,000","50%","$1,000","$2,000","$1,500","$3,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"72"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value Platinum 500","11512NC010",,"NCN002","NCS003","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100033-00","Standard Platinum Off Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"73"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value Platinum 500","11512NC010",,"NCN002","NCS003","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100033-01","Standard Platinum On Exchange Plan","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"74"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value Platinum 500","11512NC010",,"NCN002","NCS003","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100033-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"75"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100033","Blue Value Platinum 500","11512NC010",,"NCN002","NCS003","NCF002","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Platinum_500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100033-03","Limited Cost Sharing Plan Variation","88.75%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"76"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value Gold 1000","11512NC010",,"NCN002","NCS003","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100034-00","Standard Gold Off Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"77"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value Gold 1000","11512NC010",,"NCN002","NCS003","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100034-01","Standard Gold On Exchange Plan","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"78"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value Gold 1000","11512NC010",,"NCN002","NCS003","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100034-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"79"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100034","Blue Value Gold 1000","11512NC010",,"NCN002","NCS003","NCF004","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100034-03","Limited Cost Sharing Plan Variation","79.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"80"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"81"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"82"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"83"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-03","Limited Cost Sharing Plan Variation","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,800","$5,600","30%",,,,"$5,600","$11,200","$8,400","$16,800","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"84"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-04","73% AV Level Silver Plan","73.94%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$9,800","$19,600","$14,700","$29,400","$2,700","$5,400","30%",,,,"$5,400","$10,800","$8,100","$16,200","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"85"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-05","87% AV Level Silver Plan","86.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"86"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100035","Blue Value Silver 2800","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_2800.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100035-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"87"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"88"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"89"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"90"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-03","Limited Cost Sharing Plan Variation","71.71%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"91"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-04","73% AV Level Silver Plan","73.91%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%",,,,"$7,000","$14,000","$10,500","$21,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"92"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-05","87% AV Level Silver Plan","86.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$5,700","$11,400","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"93"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100036","Blue Value Silver 3500","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100036-06","94% AV Level Silver Plan","93.67%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"94"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-00","Standard Silver Off Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"95"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-01","Standard Silver On Exchange Plan","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"96"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"97"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-03","Limited Cost Sharing Plan Variation","71.84%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$5,000","$10,000","30%",,,,"$10,000","$20,000","$15,000","$30,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"98"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"99"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-05","87% AV Level Silver Plan","86.74%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"100"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0100037","Blue Value Silver 5000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100037-06","94% AV Level Silver Plan","93.73%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"101"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select Gold 1000","11512NC012",,"NCN001","NCS005","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120003-00","Standard Gold Off Exchange Plan","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"102"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select Gold 1000","11512NC012",,"NCN001","NCS005","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120003-01","Standard Gold On Exchange Plan","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"103"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select Gold 1000","11512NC012",,"NCN001","NCS005","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"104"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120003","Blue Select Gold 1000","11512NC012",,"NCN001","NCS005","NCF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Gold_1000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120003-03","Limited Cost Sharing Plan Variation","79.79%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"105"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-00","Standard Silver Off Exchange Plan","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"106"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-01","Standard Silver On Exchange Plan","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"107"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"108"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-03","Limited Cost Sharing Plan Variation","71.71%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"109"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-04","73% AV Level Silver Plan","73.98%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","$15,000","$30,000","$3,500","$7,000","30%","$3,500","$7,000","50%","$7,000","$14,000","$10,500","$21,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"110"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-05","87% AV Level Silver Plan","86.74%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$1,900","$3,800","$1,900","$3,800","$3,800","$7,600","$5,700","$11,400","$1,000","$2,000","30%","$1,000","$2,000","50%","$2,000","$4,000","$3,000","$6,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"111"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","1","11512","NC","Individual","No","56-0894904","11512NC0120004","Blue Select Silver 3500","11512NC012",,"NCN001","NCS005","NCF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_Silver_3500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bsplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0120004-06","94% AV Level Silver Plan","93.77%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$700","$1,400","$700","$1,400","$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%","$500","$1,000","50%","$1,000","$2,000","$1,500","$3,000","$200","$200","0%","$200","$200","0%","$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"112"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110001","Blue Select Gold 1000-1","11512NC011",,"NCN001","NCS004","NCF022","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Gold_1000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110001-00","Standard Gold Off Exchange Plan","80.18%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060022","Blue Advantage Gold 0","11512NC006",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060022-00","Standard Gold Off Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060022","Blue Advantage Gold 0","11512NC006",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060022-01","Standard Gold On Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110001","Blue Select Gold 1000-1","11512NC011",,"NCN001","NCS004","NCF022","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Gold_1000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110001-01","Standard Gold On Exchange Plan","80.18%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060022","Blue Advantage Gold 0","11512NC006",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060022-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110002","Blue Select Silver 2000-1","11512NC011",,"NCN001","NCS004","NCF023","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110002-00","Standard Silver Off Exchange Plan","70.86%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%","$2,000","$4,000","40%","$4,000","$8,000","$6,000","$12,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060022","Blue Advantage Gold 0","11512NC006",,"NCN001","NCS001","NCF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060022-03","Limited Cost Sharing Plan Variation","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110002","Blue Select Silver 2000-1","11512NC011",,"NCN001","NCS004","NCF023","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110002-01","Standard Silver On Exchange Plan","70.86%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%","$2,000","$4,000","40%","$4,000","$8,000","$6,000","$12,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110007","Blue Select Gold 1000-1","11512NC011",,"NCN001","NCS005","NCF022","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Gold_1000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110007-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060023","Blue Advantage Bronze 2700","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060023-00","Standard Bronze Off Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060023","Blue Advantage Bronze 2700","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060023-01","Standard Bronze On Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110007","Blue Select Gold 1000-1","11512NC011",,"NCN001","NCS005","NCF022","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Gold_1000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110007-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","20%","$1,000","$2,000","40%","$2,000","$4,000","$3,000","$6,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110008","Blue Select Silver 2000-1","11512NC011",,"NCN001","NCS005","NCF023","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110008-00","Standard Silver Off Exchange Plan","70.86%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%","$2,000","$4,000","40%","$4,000","$8,000","$6,000","$12,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060023","Blue Advantage Bronze 2700","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060023-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060023","Blue Advantage Bronze 2700","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060023-03","Limited Cost Sharing Plan Variation","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"11"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0110008","Blue Select Silver 2000-1","11512NC011",,"NCN001","NCS005","NCF023","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,"$200","0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Select_PPO_Silver_2000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0110008-01","Standard Silver On Exchange Plan","70.86%",,"No","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%","$2,000","$4,000","40%","$4,000","$8,000","$6,000","$12,000","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage Bronze 5500","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060024-00","Standard Bronze Off Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"12"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage Bronze 5500","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060024-01","Standard Bronze On Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"13"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage Bronze 5500","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060024-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060024","Blue Advantage Bronze 5500","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060024-03","Limited Cost Sharing Plan Variation","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"15"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-00","Standard Silver Off Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-01","Standard Silver On Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-03","Limited Cost Sharing Plan Variation","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-04","73% AV Level Silver Plan","72.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-05","87% AV Level Silver Plan","86.45%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0060025","Blue Advantage Silver 0","11512NC006",,"NCN001","NCS001","NCF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060025-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100026","Blue Value Gold 0","11512NC010",,"NCN002","NCS002","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100026-00","Standard Gold Off Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100026","Blue Value Gold 0","11512NC010",,"NCN002","NCS002","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100026-01","Standard Gold On Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100026","Blue Value Gold 0","11512NC010",,"NCN002","NCS002","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100026-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"25"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100026","Blue Value Gold 0","11512NC010",,"NCN002","NCS002","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100026-03","Limited Cost Sharing Plan Variation","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100027","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100027-00","Standard Bronze Off Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"27"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100027","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100027-01","Standard Bronze On Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"28"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100027","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100027-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100027","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100027-03","Limited Cost Sharing Plan Variation","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"30"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100028-00","Standard Bronze Off Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"31"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100028-01","Standard Bronze On Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"32"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100028-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"33"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100028","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100028-03","Limited Cost Sharing Plan Variation","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"34"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-00","Standard Silver Off Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-01","Standard Silver On Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"37"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-03","Limited Cost Sharing Plan Variation","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-04","73% AV Level Silver Plan","72.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-05","87% AV Level Silver Plan","86.45%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100029","Blue Value Silver 0","11512NC010",,"NCN002","NCS002","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100029-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100038","Blue Value Gold 0","11512NC010",,"NCN002","NCS003","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100038-00","Standard Gold Off Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"42"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100038","Blue Value Gold 0","11512NC010",,"NCN002","NCS003","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100038-01","Standard Gold On Exchange Plan","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100038","Blue Value Gold 0","11512NC010",,"NCN002","NCS003","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100038-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"44"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100038","Blue Value Gold 0","11512NC010",,"NCN002","NCS003","NCF006","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Gold_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100038-03","Limited Cost Sharing Plan Variation","80.62%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100039","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100039-00","Standard Bronze Off Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"46"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100039","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100039-01","Standard Bronze On Exchange Plan","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"47"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100039","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100039-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"48"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100039","Blue Value Bronze 2700","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_2700.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100039-03","Limited Cost Sharing Plan Variation","61.13%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","50%",,,,"$5,400","$10,800","$8,100","$16,200",,,,,,,,,"49"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100040-00","Standard Bronze Off Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"50"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100040-01","Standard Bronze On Exchange Plan","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"51"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100040-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"52"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100040","Blue Value Bronze 5500","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5500.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100040-03","Limited Cost Sharing Plan Variation","59.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,600","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"53"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-00","Standard Silver Off Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-01","Standard Silver On Exchange Plan","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"56"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-03","Limited Cost Sharing Plan Variation","70.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-04","73% AV Level Silver Plan","72.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"58"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-05","87% AV Level Silver Plan","86.45%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","2","11512","NC","Individual","No","56-0894904","11512NC0100041","Blue Value Silver 0","11512NC010",,"NCN002","NCS003","NCF010","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_0.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100041-06","94% AV Level Silver Plan","93.88%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$250","$750","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage Bronze 5000","11512NC006",,"NCN001","NCS001","NCF013","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060026-00","Standard Bronze Off Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040006","Blue Options Silver with HSA 2000-1","11512NC004",,"NCN001","NCS001","NCF028","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_4000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040006-00","Standard Silver Off Exchange Plan","71.39%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage Bronze 5000","11512NC006",,"NCN001","NCS001","NCF013","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060026-01","Standard Bronze On Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040006","Blue Options Silver with HSA 2000-1","11512NC004",,"NCN001","NCS001","NCF028","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Silver_2000_4000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040006-01","Standard Silver On Exchange Plan","71.39%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage Bronze 5000","11512NC006",,"NCN001","NCS001","NCF013","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060026-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040008","Blue Options Bronze with HSA 2500-1","11512NC004",,"NCN001","NCS001","NCF031","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_2500_5000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040008-00","Standard Bronze Off Exchange Plan","61.58%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060026","Blue Advantage Bronze 5000","11512NC006",,"NCN001","NCS001","NCF013","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060026-03","Limited Cost Sharing Plan Variation","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040008","Blue Options Bronze with HSA 2500-1","11512NC004",,"NCN001","NCS001","NCF031","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_2500_5000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040008-01","Standard Bronze On Exchange Plan","61.58%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040010","Blue Options Bronze with HSA 3000-2","11512NC004",,"NCN001","NCS001","NCF030","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_3000_6000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040010-00","Standard Bronze Off Exchange Plan","61.73%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-00","Standard Silver Off Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-01","Standard Silver On Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","SHOP (Small Group)","No","56-0894904","11512NC0040010","Blue Options Bronze with HSA 3000-2","11512NC004",,"NCN001","NCS001","NCF030","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.995636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","https://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Options_HSA_Bronze_3000_6000.pdf","http://www.bcbsnc.com/content/plans/smallgrp/binderpayment.htm",,"https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Enh_Alpha_Drug_List.pdf#page=1&zoom=100","11512NC0040010-01","Standard Bronze On Exchange Plan","61.73%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,"9"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-03","Limited Cost Sharing Plan Variation","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-04","73% AV Level Silver Plan","72.57%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"12"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-05","87% AV Level Silver Plan","86.08%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"13"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0060028","Blue Advantage Silver 3000","11512NC006",,"NCN001","NCS001","NCF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060028-06","94% AV Level Silver Plan","94.65%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"14"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS002","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100030-00","Standard Bronze Off Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"15"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS002","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100030-01","Standard Bronze On Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"16"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS002","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100030-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100030","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS002","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100030-03","Limited Cost Sharing Plan Variation","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"18"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-00","Standard Silver Off Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"19"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-01","Standard Silver On Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"20"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-03","Limited Cost Sharing Plan Variation","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"22"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-04","73% AV Level Silver Plan","72.54%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"23"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-05","87% AV Level Silver Plan","86.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"24"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100032","Blue Value Silver 3000","11512NC010",,"NCN002","NCS002","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100032-06","94% AV Level Silver Plan","94.65%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"25"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS003","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100042-00","Standard Bronze Off Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"26"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS003","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100042-01","Standard Bronze On Exchange Plan","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"27"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS003","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100042-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100042","Blue Value Bronze 5000","11512NC010",,"NCN002","NCS003","NCF014","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Bronze_5000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100042-03","Limited Cost Sharing Plan Variation","61.79%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"29"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-00","Standard Silver Off Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"30"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-01","Standard Silver On Exchange Plan","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"31"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-03","Limited Cost Sharing Plan Variation","68.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"33"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-04","73% AV Level Silver Plan","72.54%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200","$3,000","$6,000","30%",,,,"$6,000","$12,000","$9,000","$18,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"34"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-05","87% AV Level Silver Plan","86.09%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$1,000","$2,000","30%",,,,"$2,000","$4,000","$3,000","$6,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"35"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","3","11512","NC","Individual","No","56-0894904","11512NC0100044","Blue Value Silver 3000","11512NC010",,"NCN002","NCS003","NCF008","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","4","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Silver_3000.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100044-06","94% AV Level Silver Plan","94.65%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$1,400","$2,800","$2,100","$4,200","$500","$1,000","30%",,,,"$1,000","$2,000","$1,500","$3,000","$200","$200","0%",,,,"$200","$200","$200","$200",,,,,,,,,,,,,,,,,,,"36"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060027-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"4"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0060027","Blue Advantage Catastrophic","11512NC006",,"NCN001","NCS001","NCF015","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Advantage_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/baplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Enhanced_5T_Drug_List.pdf","11512NC0060027-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"5"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100031-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"6"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0100031","Blue Value Catastrophic","11512NC010",,"NCN002","NCS002","NCF016","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100031-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"7"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100043-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"8"
"2014","NC","11512","HIOS","9","2014-01-29 08:00:05","4","11512","NC","Individual","No","56-0894904","11512NC0100043","Blue Value Catastrophic","11512NC010",,"NCN002","NCS003","NCF016","New","POS","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Blue Card","Yes","Blue Card","Yes","http://www.bcbsnc.com/assets/shopper/public/pdf/sbc/Blue_Value_Catastrophic.pdf","https://producer.bcbsnc.com/FIM/sps/FedFundExchPayment/saml20/login","www.bcbsnc.com/bvplanbrochure","https://www.myprime.com/MyRx/MyRxHealth/forms/NC_Exchange_Basic_Drug_List.pdf","11512NC0100043-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,"9"
"2014","NC","14125","HIOS","3","2013-08-01 12:48:00","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010001","DentalConnect�","14125NC001",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"34.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"14125NC0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","14125","HIOS","3","2013-08-01 12:48:00","1","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010002","DentalConnect�","14125NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"28.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"14125NC0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","14125","HIOS","3","2013-08-01 12:48:00","2","14125","NC","SHOP (Small Group)","Yes","35-0472300","14125NC0010003","DentalConnect�","14125NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"27.11",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"14125NC0010003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","40411","HIOS","4","2013-07-31 07:05:07","1","40411","NC","Individual","Yes","59-1031071","40411NC0030001","myCigna Dental Pediatric","40411NC003","7730182962","NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"40411NC0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","1","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0170001","EHB Basic Dental Plan (Low)","40435NC017","7326041556","NCN001","NCS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$20.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48051",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48050",,"40435NC0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","1","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0170001","EHB Basic Dental Plan (Low)","40435NC017","7326041556","NCN001","NCS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$20.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48051",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48050",,"40435NC0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-03","Limited Cost Sharing Plan Variation","68.40%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030044","Bronze 100% HMO HSA Eligible CaroMont","56346NC003",,"NCN002","NCS002","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72321","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030044-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","5","27882","ND","Individual","Yes","41-0952670","27882ND0050001","Pediatric Dental A and Adult Dental D","27882ND005",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0050001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","5","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0210001","Pediatric Dental A and Adult Dental D","27882ND021",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0210001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","6","27882","ND","Individual","Yes","41-0952670","27882ND0060001","Pediatric Dental A and Adult Dental E","27882ND006",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","6","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0220001","Pediatric Dental A and Adult Dental E","27882ND022",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0220001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","6","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0220001","Pediatric Dental A and Adult Dental E","27882ND022",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0220001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030036","Silver $10 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72358","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030036-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-01","Standard Silver On Exchange Plan","68.40%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-04","73% AV Level Silver Plan","72.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030037","Silver $10 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030037-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","5","56346","NC","Individual","No","20-0229117","56346NC0030038","Bronze $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72306","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030038-01","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","5","56346","NC","Individual","No","20-0229117","56346NC0030038","Bronze $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72306","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030038-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","5","56346","NC","Individual","No","20-0229117","56346NC0030038","Bronze $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72306","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030038-03","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030044","Bronze 100% HMO HSA Eligible CaroMont","56346NC003",,"NCN002","NCS002","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72321","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030044-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","6","56346","NC","Individual","No","20-0229117","56346NC0030043","Bronze 100% POS HSA Eligible Plan","56346NC003",,"NCN005","NCS005","NCF007","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72307","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030043-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","6","56346","NC","Individual","No","20-0229117","56346NC0030043","Bronze 100% POS HSA Eligible Plan","56346NC003",,"NCN005","NCS005","NCF007","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72307","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030043-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","6","56346","NC","Individual","No","20-0229117","56346NC0030043","Bronze 100% POS HSA Eligible Plan","56346NC003",,"NCN005","NCS005","NCF007","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72307","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030043-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030044","Bronze 100% HMO HSA Eligible CaroMont","56346NC003",,"NCN002","NCS002","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72321","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030044-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","4","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0200001","Pediatric Dental A and Adult Dental C","27882ND020",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0200001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","4","27882","ND","Individual","Yes","41-0952670","27882ND0040001","Pediatric Dental A ahd Adult Dental C","27882ND004",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","4","27882","ND","Individual","Yes","41-0952670","27882ND0040001","Pediatric Dental A ahd Adult Dental C","27882ND004",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","1","56346","NC","Individual","No","20-0229117","56346NC0030028","Gold $5 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72301","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030028-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030029","Gold $0 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72315","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030029-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030031","Gold $0 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72357","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030031-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030031","Gold $0 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72357","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030031-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030029","Gold $0 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72315","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030029-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030029","Gold $0 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72315","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030029-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030030","Gold $0 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72329","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030030-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030030","Gold $0 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72329","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030030-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030030","Gold $0 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF002","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72329","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030030-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030031","Gold $0 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72357","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030031-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0150001","Guardian Pediatric Advantage","55440NC015",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0150001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0150001","Guardian Pediatric Advantage","55440NC015",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0150001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0160001","Guardian Pediatric Essentials","55440NC016",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0160001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","1","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0160001","Guardian Pediatric Essentials","55440NC016",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0160001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","2","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0170001","Guardian Family Advantage Plus","55440NC017",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0170001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","2","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0170001","Guardian Family Advantage Plus","55440NC017",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0170001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0190001","Guardian Family Essentials Plus","55440NC019",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0190001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","3","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0190001","Guardian Family Essentials Plus","55440NC019",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0190001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","4","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0180001","Guardian Family Advantage","55440NC018",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0180001-00","Standard High Off Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","4","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0180001","Guardian Family Advantage","55440NC018",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0180001-01","Standard High On Exchange Plan","84.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","4","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0200001","Guardian Family Essentials","55440NC020",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0200001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","55440","HIOS","4","2013-09-17 16:07:07","4","55440","NC","SHOP (Small Group)","Yes","13-5123390","55440NC0200001","Guardian Family Essentials","55440NC020",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.78",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"55440NC0200001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","1","56346","NC","Individual","No","20-0229117","56346NC0030028","Gold $5 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72301","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030028-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","1","56346","NC","Individual","No","20-0229117","56346NC0030028","Gold $5 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72301","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030028-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","2","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0180001","EHB Enhanced Dental Plan (High)","40435NC018","7326041556","NCN002","NCS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$25.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49096",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49095",,"40435NC0180001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","2","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0180001","EHB Enhanced Dental Plan (High)","40435NC018","7326041556","NCN002","NCS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$25.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49096",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49095",,"40435NC0180001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","3","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019","7326041556","NCN003","NCS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097",,"40435NC0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","9","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0250001","Pediatric Dental B","27882ND025",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030045","Bronze 100% HMO HSA Eligible Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030045-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","10","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0260001","Pediatric Dental B and Adult Dental A","27882ND026",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0260001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","10","27882","ND","Individual","Yes","41-0952670","27882ND0100001","Pediatric Dental B and Adult Dental A","27882ND010",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0100001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","10","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0260001","Pediatric Dental B and Adult Dental A","27882ND026",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0260001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","11","27882","ND","Individual","Yes","41-0952670","27882ND0110001","Pediatric Dental B and Adult Dental B","27882ND011",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","11","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0270001","Pediatric Dental B and Adult Dental B","27882ND027",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0270001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","11","27882","ND","Individual","Yes","41-0952670","27882ND0110001","Pediatric Dental B and Adult Dental B","27882ND011",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030045","Bronze 100% HMO HSA Eligible Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030045-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030045","Bronze 100% HMO HSA Eligible Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030045-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030046","Bronze 100% HMO HSA Eligible Duke Medicine","56346NC003",,"NCN004","NCS004","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72363","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030046-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030046","Bronze 100% HMO HSA Eligible Duke Medicine","56346NC003",,"NCN004","NCS004","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72363","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030046-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030046","Bronze 100% HMO HSA Eligible Duke Medicine","56346NC003",,"NCN004","NCS004","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72363","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030046-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","3","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0190001","Family Basic Dental Plan (Low)","40435NC019","7326041556","NCN003","NCS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$20.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49098",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49097",,"40435NC0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","4","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020","7326041556","NCN004","NCS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$25.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099",,"40435NC0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","40435","HIOS","6","2013-10-15 07:27:56","4","40435","NC","SHOP (Small Group)","Yes","13-5581829","40435NC0200001","Family Enhanced Dental Plan (High)","40435NC020","7326041556","NCN004","NCS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$25.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49100",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49099",,"40435NC0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030032","Gold $0 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72343","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030032-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$2,500","$5,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030032","Gold $0 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72343","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030032-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","2","56346","NC","Individual","No","20-0229117","56346NC0030032","Gold $0 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF002","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72343","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030032-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$2,500","$5,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-01","Standard Silver On Exchange Plan","68.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-03","Limited Cost Sharing Plan Variation","68.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-04","73% AV Level Silver Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-05","87% AV Level Silver Plan","86.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","3","56346","NC","Individual","No","20-0229117","56346NC0030033","Silver $10 Copay POS Plan","56346NC003",,"NCN005","NCS005","NCF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030033-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030034","Silver $10 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72316","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030034-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","4","56346","NC","Individual","No","20-0229117","56346NC0030035","Silver $10 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF005","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030035-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","6","27882","ND","Individual","Yes","41-0952670","27882ND0060001","Pediatric Dental A and Adult Dental E","27882ND006",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","7","27882","ND","Individual","Yes","41-0952670","27882ND0070001","Pediatric Dental A and Adult Dental F","27882ND007",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0070001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","7","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0230001","Pediatric Dental A and Adult Dental F","27882ND023",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","7","27882","ND","Individual","Yes","41-0952670","27882ND0070001","Pediatric Dental A and Adult Dental F","27882ND007",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0070001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","7","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0230001","Pediatric Dental A and Adult Dental F","27882ND023",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0230001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","8","27882","ND","Individual","Yes","41-0952670","27882ND0080001","Pediatric Dental A and Adult Dental G","27882ND008",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","8","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0240001","Pediatric Dental A and Adult Dental G","27882ND024",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual maximum out of pocket is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","8","27882","ND","Individual","Yes","41-0952670","27882ND0080001","Pediatric Dental A and Adult Dental G","27882ND008",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0080001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","8","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0240001","Pediatric Dental A and Adult Dental G","27882ND024",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual maximum out of pocket is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0240001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030047","Bronze 100% HMO HSA Eligible Cornerstone","56346NC003",,"NCN001","NCS001","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72349","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030047-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030047","Bronze 100% HMO HSA Eligible Cornerstone","56346NC003",,"NCN001","NCS001","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72349","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030047-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","7","56346","NC","Individual","No","20-0229117","56346NC0030047","Bronze 100% HMO HSA Eligible Cornerstone","56346NC003",,"NCN001","NCS001","NCF007","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NC72349","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030047-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030039","Bronze $15 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72320","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030039-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030039","Bronze $15 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72320","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030039-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030039","Bronze $15 Copay POS CaroMont","56346NC003",,"NCN002","NCS002","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72320","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030039-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030040","Bronze $15 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030040-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030040","Bronze $15 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030040-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030040","Bronze $15 Copay POS Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030040-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030041","Bronze $15 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72362","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030041-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030041","Bronze $15 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72362","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030041-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030041","Bronze $15 Copay POS Duke Medicine","56346NC003",,"NCN004","NCS004","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72362","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030041-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030042","Bronze $15 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72348","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030042-01","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030042","Bronze $15 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72348","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030042-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"14"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","8","56346","NC","Individual","No","20-0229117","56346NC0030042","Bronze $15 Copay POS Cornerstone","56346NC003",,"NCN001","NCS001","NCF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72348","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030042-03","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","9","56346","NC","Individual","No","20-0229117","56346NC0030048","Catastrophic 100% POS Plan","56346NC003",,"NCN005","NCS005","NCF007","New","POS","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-Network benefit","Yes","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72300","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posnc","www.c1formularyhix.com","56346NC0030048-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","14","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0300001","Pedatric Dental B and Adult Dental E","27882ND030",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0300001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","14","27882","ND","Individual","Yes","41-0952670","27882ND0140001","Pedatric Dental B and Adult Dental E","27882ND014",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0140001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","15","27882","ND","Individual","Yes","41-0952670","27882ND0150001","Pediatric Dental B and Adult Dental F","27882ND015",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","15","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0310001","Pediatric Dental B and Adult Dental F","27882ND031",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0310001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","15","27882","ND","Individual","Yes","41-0952670","27882ND0150001","Pediatric Dental B and Adult Dental F","27882ND015",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","15","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0310001","Pediatric Dental B and Adult Dental F","27882ND031",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0310001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","16","27882","ND","Individual","Yes","41-0952670","27882ND0160001","Pediatric Dental B and Adult Dental G","27882ND016",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440012","BlueCare 70 500","37160ND244",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440012-00","Standard Gold Off Exchange Plan",,"0.795297801494598","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$2,000","$200","$200","$560","$0","$200","14"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440013","BlueCare 70 1000","37160ND244",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440013-00","Standard Gold Off Exchange Plan",,"0.795013666152954","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$4,000","$2,000","$4,000","$1,000","$20","$1,900","$200","$200","$560","$0","$200","16"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"5"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080007-03","Limited Cost Sharing Plan Variation",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","16","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0320001","Pediatric Dental B and Adult Dental G","27882ND032",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0320001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","16","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0320001","Pediatric Dental B and Adult Dental G","27882ND032",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0320001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","16","27882","ND","Individual","Yes","41-0952670","27882ND0160001","Pediatric Dental B and Adult Dental G","27882ND016",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-03","Limited Cost Sharing Plan Variation",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-04","73% AV Level Silver Plan",,"0.721749007701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-03","Limited Cost Sharing Plan Variation",,"0.706192255020142","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$20","$1,300","$200","$200","$1,200","$0","$200","7"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440009","BlueCare 80 250","37160ND244",,"NDN001","NDS001","NDF013","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_80_250.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440009-00","Standard Platinum Off Exchange Plan",,"0.880848228931427","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$500","$1,000","$500","$1,000","$250","$20","$1,400","$200","$200","$520","$0","$200","8"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-04","73% AV Level Silver Plan",,"0.737104117870331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$1,000","$200","$200","$920","$0","$200","15"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-05","87% AV Level Silver Plan",,"0.863138735294342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$550","$1,100","20%",,,,"$1,100","$2,200","$1,100","$2,200","$550","$10","$1,300","$200","$200","$360","$0","$200","16"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050001","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0050001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","Individual","Yes","56-1018068","56891NC0030001","Delta Dental Individual, EHB Certified","56891NC003",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"56891NC0030001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050002","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","Individual","Yes","56-1018068","56891NC0030002","Delta Dental Individual, EHB Certified","56891NC003",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.48",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"56891NC0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050003","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0050003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","1","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0050004","Delta Dental Group PPO, EHB Certified","56891NC005",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0050004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","Individual","Yes","56-1018068","56891NC0040001","Delta Dental Individual Pediatric-Only, EHB Certified","56891NC004",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"56891NC0040001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060001","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0060001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","Individual","Yes","56-1018068","56891NC0040002","Delta Dental Individual Pediatric-Only, EHB Certified","56891NC004",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.48",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"56891NC0040002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060002","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$21.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060003","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0060003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","56891","HIOS","1","2013-06-07 09:05:04","2","56891","NC","SHOP (Small Group)","Yes","56-1018068","56891NC0060004","Delta Dental Group Pediatric-Only, EHB Certified","56891NC006",,"NCN001","NCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$21.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same benefit level","Yes",,,,,"56891NC0060004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010001","BEST Life Child Dental Plus","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Child_Dental_Plus_Plan.pdf",,"94482NC0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","1","94482","NC","Individual","Yes","95-6042390","94482NC0020001","BESTOne Child Dental Plus","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Child_Dental_Plus_Plan.pdf",,"94482NC0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","1","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010001","BEST Life Child Dental Plus","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Child_Dental_Plus_Plan.pdf",,"94482NC0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","1","94482","NC","Individual","Yes","95-6042390","94482NC0020001","BESTOne Child Dental Plus","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Child_Dental_Plus_Plan.pdf",,"94482NC0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010002","BEST Life Child Dental","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Child_Dental_Plan.pdf",,"94482NC0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","2","94482","NC","Individual","Yes","95-6042390","94482NC0020002","BESTOne Child Dental","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Child_Dental_Plan.pdf",,"94482NC0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","2","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010002","BEST Life Child Dental","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Child_Dental_Plan.pdf",,"94482NC0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","2","94482","NC","Individual","Yes","95-6042390","94482NC0020002","BESTOne Child Dental","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Child_Dental_Plan.pdf",,"94482NC0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010003","BEST Dental Advantage - Gold","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Advantage_Plan_(Gold).pdf",,"94482NC0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-06","94% AV Level Silver Plan",,"0.932118773460388","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$10","$700","$200","$0","$360","$20","$200","17"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440013","BlueCare 70 1000","37160ND244",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440013-01","Standard Gold On Exchange Plan",,"0.795013666152954","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$4,000","$2,000","$4,000","$1,000","$20","$1,900","$200","$200","$560","$0","$200","17"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440014","BlueCare 70 2000","37160ND244",,"NDN001","NDS001","NDF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareSilver_70_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440014-00","Standard Silver Off Exchange Plan",,"0.715322315692902","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$1,600","$200","$200","$920","$0","$200","18"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410011","BlueDirect 70 4000","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_70_4000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","14"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440006","BlueDirect 50 3500","37160ND244",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectBronze_50_3500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440006-01","Standard Bronze On Exchange Plan","59.10%","0.599059820175171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$7,000","$14,000","$7,000","$14,000","$3,500","$0","$1,800","$200","$3,500","$0","$400","$200","15"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410011","BlueDirect 70 4000","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_70_4000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410011-03","Limited Cost Sharing Plan Variation","59.20%","0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$8,000","$16,000","$4,000","$0","$1,000","$200","$4,000","$0","$80","$200","15"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410012","BlueDirect 50 3000","37160ND241",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_50_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410012-00","Standard Bronze Off Exchange Plan","59.90%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$0","$2,100","$200","$3,000","$0","$630","$200","16"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440012","BlueCare 70 500","37160ND244",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440012-01","Standard Gold On Exchange Plan",,"0.795297801494598","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$2,000","$200","$200","$560","$0","$200","15"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","10","56346","NC","Individual","No","20-0229117","56346NC0030049","Catastrophic 100% HMO CaroMont","56346NC003",,"NCN002","NCS002","NCF007","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out-of-Network benefit","No","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72314","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscaromontnc","www.c1formularyhix.com","56346NC0030049-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","10","56346","NC","Individual","No","20-0229117","56346NC0030050","Catastrophic 100% HMO Carolinas HealthCare System","56346NC003",,"NCN003","NCS003","NCF007","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out-of-Network benefit","No","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72328","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscarolinashealthcaresystemnc","www.c1formularyhix.com","56346NC0030050-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","10","56346","NC","Individual","No","20-0229117","56346NC0030051","Catastrophic 100% HMO Duke Medicine","56346NC003",,"NCN004","NCS004","NCF007","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out-of-Network benefit","No","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72356","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posdukenc","www.c1formularyhix.com","56346NC0030051-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NC","56346","HIOS","6","2013-10-15 07:27:56","10","56346","NC","Individual","No","20-0229117","56346NC0030052","Catastrophic 100% HMO Cornerstone","56346NC003",,"NCN001","NCS001","NCF007","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out-of-Network benefit","No","Out-of-Network benefit","No","http://www.coventryhealthcare.com/NC72342","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poscornerstonenc","www.c1formularyhix.com","56346NC0030052-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","Individual","Yes","95-6042390","94482NC0020003","BESTOne Dental Advantage - Gold","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"94482NC0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010003","BEST Dental Advantage - Gold","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Advantage_Plan_(Gold).pdf",,"94482NC0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","Individual","Yes","95-6042390","94482NC0020003","BESTOne Dental Advantage - Gold","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"94482NC0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","Individual","Yes","95-6042390","94482NC0020004","BESTOne Dental Plus - Gold","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"94482NC0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010004","BEST Dental Plus - Gold","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Plus_Plan_(Gold).pdf",,"94482NC0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","Individual","Yes","95-6042390","94482NC0020004","BESTOne Dental Plus - Gold","94482NC002",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"94482NC0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","3","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010004","BEST Dental Plus - Gold","94482NC001",,"NCN001","NCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Plus_Plan_(Gold).pdf",,"94482NC0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010005","BEST Dental Plus - Silver","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Plus_Plan_(Silver).pdf",,"94482NC0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","Individual","Yes","95-6042390","94482NC0020005","BESTOne Dental Plus - Silver","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"94482NC0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010005","BEST Dental Plus - Silver","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Plus_Plan_(Silver).pdf",,"94482NC0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","Individual","Yes","95-6042390","94482NC0020005","BESTOne Dental Plus - Silver","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"94482NC0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","Individual","Yes","95-6042390","94482NC0020006","BESTOne Dental Basic - Silver","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"94482NC0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010006","BEST Dental Basic - Silver","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Basic_Plan_(Silver).pdf",,"94482NC0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","Individual","Yes","95-6042390","94482NC0020006","BESTOne Dental Basic - Silver","94482NC002",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"94482NC0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NC","94482","HIOS","9","2014-01-21 08:29:49","4","94482","NC","SHOP (Small Group)","Yes","95-6042390","94482NC0010006","BEST Dental Basic - Silver","94482NC001",,"NCN001","NCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NC/pdf/NC_BEST_Dental_Basic_Plan_(Silver).pdf",,"94482NC0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","1","27882","ND","Individual","Yes","41-0952670","27882ND0010001","Pediatric Dental A","27882ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","1","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0170001","Pediatric Dental A","27882ND017",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age 18",,,,,"Allows Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","1","27882","ND","Individual","Yes","41-0952670","27882ND0010001","Pediatric Dental A","27882ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","1","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0170001","Pediatric Dental A","27882ND017",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age 18",,,,,"Allows Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","2","27882","ND","Individual","Yes","41-0952670","27882ND0020001","Pediatric Dental A and Adult Dental A","27882ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","2","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0180001","Pediatric Dental A and Adult Dental A","27882ND018",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","2","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0180001","Pediatric Dental A and Adult Dental A","27882ND018",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","2","27882","ND","Individual","Yes","41-0952670","27882ND0020001","Pediatric Dental A and Adult Dental A","27882ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","3","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0190001","Pediatric Dental A and Adult Dental B","27882ND019",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","3","27882","ND","Individual","Yes","41-0952670","27882ND0030001","Pediatric Dental A and Adult Dental B","27882ND003",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","3","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0190001","Pediatric Dental A and Adult Dental B","27882ND019",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","3","27882","ND","Individual","Yes","41-0952670","27882ND0030001","Pediatric Dental A and Adult Dental B","27882ND003",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","4","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0200001","Pediatric Dental A and Adult Dental C","27882ND020",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0200001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","5","27882","ND","Individual","Yes","41-0952670","27882ND0050001","Pediatric Dental A and Adult Dental D","27882ND005",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","5","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0210001","Pediatric Dental A and Adult Dental D","27882ND021",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","9","27882","ND","Individual","Yes","41-0952670","27882ND0090001","Pediatric Dental B","27882ND009",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","9","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0250001","Pediatric Dental B","27882ND025",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0250001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","9","27882","ND","Individual","Yes","41-0952670","27882ND0090001","Pediatric Dental B","27882ND009",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","10","27882","ND","Individual","Yes","41-0952670","27882ND0100001","Pediatric Dental B and Adult Dental A","27882ND010",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","11","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0270001","Pediatric Dental B and Adult Dental B","27882ND027",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0270001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","12","27882","ND","Individual","Yes","41-0952670","27882ND0120001","Pediatric Dental B and Adult Dental C","27882ND012",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0120001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","12","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0280001","Pediatric Dental B and Adult Dental C","27882ND028",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0280001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","12","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0280001","Pediatric Dental B and Adult Dental C","27882ND028",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0280001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","12","27882","ND","Individual","Yes","41-0952670","27882ND0120001","Pediatric Dental B and Adult Dental C","27882ND012",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0120001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","13","27882","ND","Individual","Yes","41-0952670","27882ND0130001","Pediatric Dental B and Adult Dental D","27882ND013",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","13","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0290001","Pediatric Dental B and Adult Dental D","27882ND029",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0290001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","13","27882","ND","Individual","Yes","41-0952670","27882ND0130001","Pediatric Dental B and Adult Dental D","27882ND013",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","13","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0290001","Pediatric Dental B and Adult Dental D","27882ND029",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0290001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","14","27882","ND","Individual","Yes","41-0952670","27882ND0140001","Pedatric Dental B and Adult Dental E","27882ND014",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0140001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","27882","HIOS","2","2013-09-25 08:49:23","14","27882","ND","SHOP (Small Group)","Yes","41-0952670","27882ND0300001","Pedatric Dental B and Adult Dental E","27882ND030",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$27.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area","Yes",,,,,"27882ND0300001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440010","BlueCare 90 1500","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440010-00","Standard Gold Off Exchange Plan",,"0.794349551200867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$600","$200","$200","$560","$0","$200","10"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-00","Standard Silver Off Exchange Plan",,"0.688331663608551","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$5,000","$10,000","$2,500","$20","$900","$200","$200","$1,200","$0","$200","11"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410011","BlueDirect 70 4000","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_70_4000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410011-01","Standard Bronze On Exchange Plan","59.20%","0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$8,000","$16,000","$4,000","$0","$1,000","$200","$4,000","$0","$80","$200","13"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440006","BlueDirect 50 3500","37160ND244",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectBronze_50_3500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440006-00","Standard Bronze Off Exchange Plan","59.10%","0.599059820175171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$7,000","$14,000","$7,000","$14,000","$3,500","$0","$1,800","$200","$3,500","$0","$400","$200","14"
"2014","ND","33011","HIOS","2","2013-07-02 22:25:47","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0040002","EHB High PPO","33011ND004",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.56",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"33011ND0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","33011","HIOS","2","2013-07-02 22:25:47","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0040001","EHB Low PPO","33011ND004",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"33011ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440007","BlueCare 90 500","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_90_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440007-01","Standard Platinum On Exchange Plan",,"0.885922431945801","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$700","$200","$200","$520","$0","$200","5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-01","Standard Silver On Exchange Plan",,"0.706192255020142","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$20","$1,300","$200","$200","$1,200","$0","$200","5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440008","BlueCare 80 0","37160ND244",,"NDN001","NDS001","NDF013","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_80_0.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440008-00","Standard Platinum Off Exchange Plan",,"0.88532292842865","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","$0","$0","$0","$20","$1,400","$200","$0","$560","$0","$200","6"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","6"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440008","BlueCare 80 0","37160ND244",,"NDN001","NDS001","NDF013","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_80_0.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440008-01","Standard Platinum On Exchange Plan",,"0.88532292842865","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","$0","$0","$0","$20","$1,400","$200","$0","$560","$0","$200","7"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090001","Medica Essential ND 1300-20% HSA Gold","73751ND009",,"NDN001","NDS001","NDF001","New","POS","Gold","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090001-00","Standard Gold Off Exchange Plan",,"0.780426740646362","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$1,300","$0","$700","$1,000","$1,300","$0","$800","$0","4"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090001","Medica Essential ND 1300-20% HSA Gold","73751ND009",,"NDN001","NDS001","NDF001","New","POS","Gold","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090001-01","Standard Gold On Exchange Plan",,"0.780426740646362","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$1,300","$0","$700","$1,000","$1,300","$0","$800","$0","5"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"5"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080001-03","Limited Cost Sharing Plan Variation",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410017","BlueDirect 90 1400","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_90_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410017-01","Standard Gold On Exchange Plan","78.20%","0.787173211574554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,150","$6,300",,,"$6,300","$12,600","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","10%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$600","$200","$1,400","$0","$290","$200","39"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410017","BlueDirect 90 1400","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_90_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","40"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410017","BlueDirect 90 1400","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_90_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410017-03","Limited Cost Sharing Plan Variation","78.20%","0.787173211574554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,150","$6,300",,,"$6,300","$12,600","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","10%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$600","$200","$1,400","$0","$290","$200","41"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect 100 1900","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410018-00","Standard Gold Off Exchange Plan","78.80%","0.795941472053528","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$5,700","$11,400","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$0","$200","$1,900","$0","$0","$200","42"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare 70 500","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410005-03","Limited Cost Sharing Plan Variation",,"0.794382929801941","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$2,000","$200","$200","$560","$0","$200","21"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410006","BlueCare 70 1000","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410006-00","Standard Gold Off Exchange Plan",,"0.794280350208282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$4,000","$2,000","$4,000","$1,000","$20","$1,900","$200","$200","$560","$0","$200","22"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080012","Medica Applause Bronze  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080012-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","3","73751","ND","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Catastrophic","No","Both","No","No",,"Medica’s catastrophic plan will be a full family plan (“adult only”), meaning an adult policyholder is required when a dependent child under age 21 is enrolled.  However “adult and child only” is selected due to the template’s error requiring a corresponding child-only plan with an adult-only offering.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCatastrophic","www.medica.com/IFBPharmacy","73751ND0080013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ND","93236","HIOS","2","2013-07-01 08:34:30","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0030002","EHB High Passive","93236ND003",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.28",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"93236ND0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","93236","HIOS","2","2013-07-01 08:34:30","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0030001","EHB Low Passive","93236ND003",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.48",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"93236ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-03","Limited Cost Sharing Plan Variation","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-04","73% AV Level Silver Plan","73.54%","0.735447406768799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,350","$12,700","$6,350","$12,700","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050003","CorePlatinum","10191NJ005",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060003","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050003-00","Standard Platinum Off Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410006","BlueCare 70 1000","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410006-01","Standard Gold On Exchange Plan",,"0.794280350208282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$4,000","$2,000","$4,000","$1,000","$20","$1,900","$200","$200","$560","$0","$200","23"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410006","BlueCare 70 1000","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","24"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410006","BlueCare 70 1000","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_1000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410006-03","Limited Cost Sharing Plan Variation",,"0.794280350208282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"$2,000","$4,000","$2,000","$4,000","$1,000","$20","$1,900","$200","$200","$560","$0","$200","25"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410007","BlueCare 90 2000","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410007-00","Standard Gold Off Exchange Plan",,"0.782534062862396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$500","$200","$200","$560","$0","$200","26"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-05","87% AV Level Silver Plan","87.10%","0.872048735618591","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$0","$700","$200","$500","$0","$380","$200","25"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-06","94% AV Level Silver Plan","93.10%","0.931063115596771","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$0","$700","$200","$0","$0","$420","$200","26"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100001","PrimeBronze","10191NJ010",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100001-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","PrimeBronze","10191NJ003",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100002","PrimeSilver","10191NJ010",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100002-00","Standard Silver Off Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","PrimeBronze","10191NJ003",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030001-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100002","PrimeSilver","10191NJ010",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100002-01","Standard Silver On Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ND","93236","HIOS","2","2013-07-01 08:34:30","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0040002","EHB High PPO","93236ND004",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.96",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"93236ND0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090003","Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090003-00","Standard Bronze Off Exchange Plan",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"4"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100004","Simplicity $3,000","89364ND010",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100004-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect 100 1900","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410018-01","Standard Gold On Exchange Plan","78.80%","0.795941472053528","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$5,700","$11,400","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$0","$200","$1,900","$0","$0","$200","43"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect 100 1900","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$0","44"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze  H S A","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080011-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze  H S A","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"26"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze  H S A","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080011-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080012","Medica Applause Bronze  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080012-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080012","Medica Applause Bronze  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080012-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080012","Medica Applause Bronze  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"30"
"2014","ND","33011","HIOS","2","2013-07-02 22:25:47","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0030002","EHB High Passive","33011ND003",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.04",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"33011ND0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","33011","HIOS","2","2013-07-02 22:25:47","1","33011","ND","SHOP (Small Group)","Yes","93-0242990","33011ND0030001","EHB Low Passive","33011ND003",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.00",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"33011ND0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","1","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0010001","Guardian Pediatric Advantage","33889ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","1","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0010001","Guardian Pediatric Advantage","33889ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","1","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0020001","Guardian Pediatric Essentials","33889ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0020001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","1","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0020001","Guardian Pediatric Essentials","33889ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0020001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","2","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0030001","Guardian Family Advantage Plus","33889ND003",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","2","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0030001","Guardian Family Advantage Plus","33889ND003",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0030001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","3","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0050001","Guardian Family Essentials Plus","33889ND005",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0050001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","3","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0050001","Guardian Family Essentials Plus","33889ND005",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0050001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","4","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0040001","Guardian Family Advantage","33889ND004",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","4","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0040001","Guardian Family Advantage","33889ND004",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","4","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0060001","Guardian Family Essentials","33889ND006",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0060001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","33889","HIOS","6","2013-09-17 16:07:07","4","33889","ND","SHOP (Small Group)","Yes","13-5123390","33889ND0060001","Guardian Family Essentials","33889ND006",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"33889ND0060001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-00","Standard Silver Off Exchange Plan",,"0.706192255020142","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$20","$1,300","$200","$200","$1,200","$0","$200","4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440007","BlueCare 90 500","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_90_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440007-00","Standard Platinum Off Exchange Plan",,"0.885922431945801","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$700","$200","$200","$520","$0","$200","4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-04","73% AV Level Silver Plan",,"0.737104117870331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$1,000","$200","$200","$920","$0","$200","8"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-05","87% AV Level Silver Plan",,"0.863138735294342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$550","$1,100","20%",,,,"$1,100","$2,200","$1,100","$2,200","$550","$10","$1,300","$200","$200","$360","$0","$200","9"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440009","BlueCare 80 250","37160ND244",,"NDN001","NDS001","NDF013","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCarePlatinum_80_250.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440009-01","Standard Platinum On Exchange Plan",,"0.880848228931427","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$500","$1,000","$500","$1,000","$250","$20","$1,400","$200","$200","$520","$0","$200","9"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410002","BlueCare 70 3000","37160ND241",,"NDN001","NDS001","NDF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver70_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410002-06","94% AV Level Silver Plan",,"0.932118773460388","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$10","$700","$200","$0","$360","$20","$200","10"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440010","BlueCare 90 1500","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440010-01","Standard Gold On Exchange Plan",,"0.794349551200867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$600","$200","$200","$560","$0","$200","11"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440011","BlueCare 90 2000","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440011-00","Standard Gold Off Exchange Plan",,"0.782534062862396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$500","$200","$200","$560","$0","$200","12"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-01","Standard Silver On Exchange Plan",,"0.688331663608551","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$5,000","$10,000","$2,500","$20","$900","$200","$200","$1,200","$0","$200","12"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","13"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440011","BlueCare 90 2000","37160ND244",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440011-01","Standard Gold On Exchange Plan",,"0.782534062862396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$500","$200","$200","$560","$0","$200","13"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410004","BlueCare 80 2500","37160ND241",,"NDN001","NDS001","NDF004","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareSilver_80_2500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410004-03","Limited Cost Sharing Plan Variation",,"0.688331663608551","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$5,000","$10,000","$2,500","$20","$900","$200","$200","$1,200","$0","$200","14"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare 70 500","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410005-00","Standard Gold Off Exchange Plan",,"0.794382929801941","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$2,000","$200","$200","$560","$0","$200","18"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440014","BlueCare 70 2000","37160ND244",,"NDN001","NDS001","NDF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareSilver_70_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440014-01","Standard Silver On Exchange Plan",,"0.715322315692902","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$1,600","$200","$200","$920","$0","$200","19"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare 70 500","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410005-01","Standard Gold On Exchange Plan",,"0.794382929801941","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$20","$2,000","$200","$200","$560","$0","$200","19"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440015","BlueCare 60 1500","37160ND244",,"NDN001","NDS001","NDF012","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareSilver_60_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440015-00","Standard Silver Off Exchange Plan",,"0.699591517448425","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","40%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$2,300","$200","$200","$1,200","$0","$200","20"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410005","BlueCare 70 500","37160ND241",,"NDN001","NDS001","NDF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_70_500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","20"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440015","BlueCare 60 1500","37160ND244",,"NDN001","NDS001","NDF012","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueCareSilver_60_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440015-01","Standard Silver On Exchange Plan",,"0.699591517448425","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","40%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$2,300","$200","$200","$1,200","$0","$200","21"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410007","BlueCare 90 2000","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410007-01","Standard Gold On Exchange Plan",,"0.782534062862396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$500","$200","$200","$560","$0","$200","27"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410007","BlueCare 90 2000","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","28"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410007","BlueCare 90 2000","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_2000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410007-03","Limited Cost Sharing Plan Variation",,"0.782534062862396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$4,000","$8,000","$4,000","$8,000","$2,000","$20","$500","$200","$200","$560","$0","$200","29"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410008","BlueCare 90 1500","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410008-00","Standard Gold Off Exchange Plan",,"0.794349551200867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$600","$200","$200","$560","$0","$200","30"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410008","BlueCare 90 1500","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410008-01","Standard Gold On Exchange Plan",,"0.794349551200867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$600","$200","$200","$560","$0","$200","31"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410008","BlueCare 90 1500","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","32"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","1","37160","ND","Individual","No","45-0173185","37160ND2410008","BlueCare 90 1500","37160ND241",,"NDN001","NDS001","NDF006","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueCareGold_90_1500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410008-03","Limited Cost Sharing Plan Variation",,"0.794349551200867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","$3,000","$6,000","$1,500","$20","$600","$200","$200","$560","$0","$200","33"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect 100 1900","37160ND244",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440001-00","Standard Gold Off Exchange Plan","78.80%","0.795941472053528","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$5,700","$11,400","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$0","$200","$1,900","$0","$0","$200","4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410009","BlueDirect 100 5200","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_100_5200.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410009-00","Standard Bronze Off Exchange Plan","59.40%","0.621888637542725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400","0%",,,,"$10,400","$20,800","$10,400","$20,800","$5,200","$0","$0","$200","$4,260","$0","$0","$200","4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440001","BlueDirect 100 1900","37160ND244",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440001-01","Standard Gold On Exchange Plan","78.80%","0.795941472053528","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$5,700","$11,400","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$0","$200","$1,900","$0","$0","$200","5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410009","BlueDirect 100 5200","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_100_5200.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410009-01","Standard Bronze On Exchange Plan","59.40%","0.621888637542725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400","0%",,,,"$10,400","$20,800","$10,400","$20,800","$5,200","$0","$0","$200","$4,260","$0","$0","$200","5"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440002","BlueDirect 90 1300","37160ND244",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_90_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440002-00","Standard Gold Off Exchange Plan","79.00%","0.793896555900574","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,400","$12,800","$6,400","$12,800",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$600","$200","$1,300","$0","$300","$200","6"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410009","BlueDirect 100 5200","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_100_5200.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","6"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410009","BlueDirect 100 5200","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_100_5200.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410009-03","Limited Cost Sharing Plan Variation","59.40%","0.621888637542725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$5,200","$10,400","0%",,,,"$10,400","$20,800","$10,400","$20,800","$5,200","$0","$0","$200","$4,260","$0","$0","$200","7"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440002","BlueDirect 90 1300","37160ND244",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_90_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440002-01","Standard Gold On Exchange Plan","79.00%","0.793896555900574","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,400","$12,800","$6,400","$12,800",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$600","$200","$1,300","$0","$300","$200","7"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440003","BlueDirect 80 1300","37160ND244",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_80_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440003-00","Standard Gold Off Exchange Plan","78.70%","0.789663672447205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$4,700",,,"$4,700","$9,400","$4,700","$9,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$1,200","$200","$1,300","$0","$600","$200","8"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410010","BlueDirect 90 4500","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_90_4500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410010-00","Standard Bronze Off Exchange Plan","59.50%","0.616446435451508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$9,000","$18,000","$9,000","$18,000","$4,500","$0","$300","$200","$4,260","$0","$0","$200","8"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440003","BlueDirect 80 1300","37160ND244",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectGold_80_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440003-01","Standard Gold On Exchange Plan","78.70%","0.789663672447205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$4,700",,,"$4,700","$9,400","$4,700","$9,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$1,200","$200","$1,300","$0","$600","$200","9"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410010","BlueDirect 90 4500","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_90_4500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410010-01","Standard Bronze On Exchange Plan","59.50%","0.616446435451508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$9,000","$18,000","$9,000","$18,000","$4,500","$0","$300","$200","$4,260","$0","$0","$200","9"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect 80 1900","37160ND244",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectSilver_80_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440004-00","Standard Silver Off Exchange Plan","68.40%","0.691471874713898","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$1,100","$200","$1,900","$0","$480","$200","10"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410010","BlueDirect 90 4500","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_90_4500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","10"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440004","BlueDirect 80 1900","37160ND244",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectSilver_80_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440004-01","Standard Silver On Exchange Plan","68.40%","0.691471874713898","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$1,100","$200","$1,900","$0","$480","$200","11"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410010","BlueDirect 90 4500","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_90_4500.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410010-03","Limited Cost Sharing Plan Variation","59.50%","0.616446435451508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$9,000","$18,000","$9,000","$18,000","$4,500","$0","$300","$200","$4,260","$0","$0","$200","11"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440005","BlueDirect 70 1300","37160ND244",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectSilver_70_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440005-00","Standard Silver Off Exchange Plan","69.00%","0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$1,800","$200","$1,300","$0","$900","$200","12"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410011","BlueDirect 70 4000","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_70_4000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410011-00","Standard Bronze Off Exchange Plan","59.20%","0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$8,000","$16,000","$4,000","$0","$1,000","$200","$4,000","$0","$80","$200","12"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","SHOP (Small Group)","No","45-0173185","37160ND2440005","BlueDirect 70 1300","37160ND244",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc",,"http://secure.bswift.com/document/bcbsdocs/SGBlueDirectSilver_70_1300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2440005-01","Standard Silver On Exchange Plan","69.00%","0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$2,600","$5,200","$2,600","$5,200","$1,300","$0","$1,800","$200","$1,300","$0","$900","$200","13"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410012","BlueDirect 50 3000","37160ND241",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_50_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410012-01","Standard Bronze On Exchange Plan","59.90%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$0","$2,100","$200","$3,000","$0","$630","$200","17"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410012","BlueDirect 50 3000","37160ND241",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_50_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","18"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080006","Medica Applause Bronze Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080006-01","Standard Bronze On Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080006","Medica Applause Bronze Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"30"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080006","Medica Applause Bronze Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080006-03","Limited Cost Sharing Plan Variation",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080007","Medica Applause Gold H S A","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080007-01","Standard Gold On Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080008","Medica Applause Gold  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080008-01","Standard Gold On Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080008","Medica Applause Gold  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"8"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080008","Medica Applause Gold  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF007","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080008-03","Limited Cost Sharing Plan Variation",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-00","Standard Silver Off Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-01","Standard Silver On Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"12"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410012","BlueDirect 50 3000","37160ND241",,"NDN001","NDS001","NDF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectBronze_50_3000.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410012-03","Limited Cost Sharing Plan Variation","59.90%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","$6,000","$12,000","$3,000","$0","$2,100","$200","$3,000","$0","$630","$200","19"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-00","Standard Silver Off Exchange Plan","68.50%","0.687832772731781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","30%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,700","$200","$1,400","$0","$860","$200","20"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"19"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-03","Limited Cost Sharing Plan Variation",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-04","73% AV Level Silver Plan",,"0.721749007701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-05","87% AV Level Silver Plan",,"0.862255096435547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-06","94% AV Level Silver Plan",,"0.935520946979523","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$450","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080011","Medica Applause Bronze  H S A","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080011-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-01","Standard Silver On Exchange Plan","68.50%","0.687832772731781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","30%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,700","$200","$1,400","$0","$860","$200","21"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","22"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-03","Limited Cost Sharing Plan Variation","68.50%","0.687832772731781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$12,700","$25,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","30%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,700","$200","$1,400","$0","$860","$200","23"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410013","BlueDirect 70 1400","37160ND241",,"NDN001","NDS001","NDF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_70_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410013-04","73% AV Level Silver Plan","73.50%","0.739061772823334","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,200","$200","$1,400","$0","$570","$200","24"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-00","Standard Silver Off Exchange Plan","68.40%","0.691800951957703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","20%",,,,"$4,600","$9,200","$4,600","$9,200","$2,300","$0","$1,000","$200","$2,300","$0","$370","$200","27"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-01","Standard Silver On Exchange Plan","68.40%","0.691800951957703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","20%",,,,"$4,600","$9,200","$4,600","$9,200","$2,300","$0","$1,000","$200","$2,300","$0","$370","$200","28"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","29"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-03","Limited Cost Sharing Plan Variation","68.40%","0.691800951957703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","20%",,,,"$4,600","$9,200","$4,600","$9,200","$2,300","$0","$1,000","$200","$2,300","$0","$370","$200","30"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-04","73% AV Level Silver Plan","73.50%","0.739061772823334","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,200","$200","$1,400","$0","$570","$200","31"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-05","87% AV Level Silver Plan","87.10%","0.872048735618591","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,000","$2,000","$500","$0","$700","$200","$500","$0","$380","$200","32"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410014","BlueDirect 80 2300","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectSilver_80_2300.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410014-06","94% AV Level Silver Plan","93.10%","0.931063115596771","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$3,800","$7,600","$3,800","$7,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$0","$700","$200","$0","$0","$420","$200","33"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410016","BlueDirect 80 1400","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_80_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410016-00","Standard Gold Off Exchange Plan","78.10%","0.785123765468597","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$4,700",,,"$4,700","$9,400","$4,700","$9,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,000","$200","$1,400","$0","$570","$200","34"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410016","BlueDirect 80 1400","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_80_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410016-01","Standard Gold On Exchange Plan","78.10%","0.785123765468597","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$4,700",,,"$4,700","$9,400","$4,700","$9,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,000","$200","$1,400","$0","$570","$200","35"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410016","BlueDirect 80 1400","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_80_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","36"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410016","BlueDirect 80 1400","37160ND241",,"NDN001","NDS001","NDF011","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_80_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410016-03","Limited Cost Sharing Plan Variation","78.10%","0.785123765468597","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$4,700",,,"$4,700","$9,400","$4,700","$9,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$1,000","$200","$1,400","$0","$570","$200","37"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410017","BlueDirect 90 1400","37160ND241",,"NDN001","NDS001","NDF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_90_1400.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410017-00","Standard Gold Off Exchange Plan","78.20%","0.787173211574554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,150","$6,300",,,"$6,300","$12,600","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","10%",,,,"$2,800","$5,600","$2,800","$5,600","$1,400","$0","$600","$200","$1,400","$0","$290","$200","38"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","2","37160","ND","Individual","No","45-0173185","37160ND2410018","BlueDirect 100 1900","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueDirectGold_100_1900.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410018-03","Limited Cost Sharing Plan Variation","78.80%","0.795941472053528","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$5,700","$11,400","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","0%",,,,"$3,800","$7,600","$3,800","$7,600","$1,900","$0","$0","$200","$1,900","$0","$0","$200","45"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","3","37160","ND","Individual","No","45-0173185","37160ND2410019","BlueEssential 100 6350","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueEssential.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$12,700","$25,400","$6,350","$0","$0","$200","$4,260","$0","$0","$200","4"
"2014","ND","37160","HIOS","6","2014-01-21 08:29:49","3","37160","ND","Individual","No","45-0173185","37160ND2410019","BlueEssential 100 6350","37160ND241",,"NDN001","NDS001","NDF007","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Benefit Plan are also available to Members traveling or living outside of the United States. The Preauthorization and Prior Approval requirements will apply","Yes","Whenever member obtains healthcare services outside of the service area, claims will be processed at the in-network level if visiting providers participating with the Preferred Blue PPO Network.","Yes","www.bcbsnd.com/sbc","www.bcbsnd.com/pay","http://secure.bswift.com/document/bcbsdocs/BlueEssential.pdf","https://www.bcbsnd.com/documents/10476/35343/qualified_formulary.pdf/7279c824-18b2-4817-b039-6b9146951bf6","37160ND2410019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$12,700","$25,400","$6,350","$0","$0","$200","$4,260","$0","$0","$200","5"
"2014","ND","40479","HIOS","1","2013-06-07 09:05:04","1","40479","ND","SHOP (Small Group)","Yes","35-0472300","40479ND0010001","DentalConnect�","40479ND001",,"NDN001","NDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.50",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"40479ND0010001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","40479","HIOS","1","2013-06-07 09:05:04","1","40479","ND","SHOP (Small Group)","Yes","35-0472300","40479ND0010002","DentalConnect�","40479ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"40479ND0010002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","40479","HIOS","1","2013-06-07 09:05:04","2","40479","ND","SHOP (Small Group)","Yes","35-0472300","40479ND0010003","DentalConnect�","40479ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"40479ND0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080001","Medica Applause Gold Copay","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080001-01","Standard Gold On Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090002","Medica Essential ND 1750-25% HSA Silver","73751ND009",,"NDN001","NDS001","NDF002","New","POS","Silver","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090002-00","Standard Silver Off Exchange Plan",,"0.680849492549896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"$5,000","$9,900","Not Applicable","Not Applicable","$1,750","$0","$800","$1,000","$1,750","$0","$900","$0","6"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080002","Medica Applause Gold Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080002-01","Standard Gold On Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090002","Medica Essential ND 1750-25% HSA Silver","73751ND009",,"NDN001","NDS001","NDF002","New","POS","Silver","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090002-01","Standard Silver On Exchange Plan",,"0.680849492549896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"$5,000","$9,900","Not Applicable","Not Applicable","$1,750","$0","$800","$1,000","$1,750","$0","$900","$0","7"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090003","Medica Essential ND 4950-50% HSA Bronze","73751ND009",,"NDN001","NDS001","NDF003","New","POS","Bronze","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090003-00","Standard Bronze Off Exchange Plan",,"0.583925843238831","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900","50%",,,,"$7,500","$9,900","Not Applicable","Not Applicable","$4,800","$0","$0","$1,000","$4,950","$0","$200","$0","8"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080002","Medica Applause Gold Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"8"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","SHOP (Small Group)","No","41-1242261","73751ND0090003","Medica Essential ND 4950-50% HSA Bronze","73751ND009",,"NDN001","NDS001","NDF003","New","POS","Bronze","No","Both","No","Yes","Any provider outside the members care system network.",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes"," Out-of-Network benefits apply.","No","www.medica.com/SHOPEssentialSBC",,"www.medica.com/SHOPEssentialBrochure","www.medica.com/SHOPPharmacy","73751ND0090003-01","Standard Bronze On Exchange Plan",,"0.583925843238831","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900","50%",,,,"$7,500","$9,900","Not Applicable","Not Applicable","$4,800","$0","$0","$1,000","$4,950","$0","$200","$0","9"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080002","Medica Applause Gold Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080002-03","Limited Cost Sharing Plan Variation",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-00","Standard Silver Off Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-01","Standard Silver On Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"12"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-03","Limited Cost Sharing Plan Variation",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-04","73% AV Level Silver Plan",,"0.720300376415253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,850","$5,550","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-05","87% AV Level Silver Plan",,"0.861329793930054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$600","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080003","Medica Applause Silver Copay","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080003-06","94% AV Level Silver Plan",,"0.931984722614288","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-00","Standard Silver Off Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-01","Standard Silver On Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"19"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-03","Limited Cost Sharing Plan Variation",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-04","73% AV Level Silver Plan",,"0.720300376415253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,850","$5,550","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-05","87% AV Level Silver Plan",,"0.861329793930054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$600","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080004","Medica Applause Silver Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080004-06","94% AV Level Silver Plan",,"0.931984722614288","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080005-00","Standard Bronze Off Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080005-01","Standard Bronze On Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$10,000","$20,000","$0","$0",,,,,,,,,"26"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080005","Medica Applause Bronze Copay","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","73751ND0080006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080005-03","Limited Cost Sharing Plan Variation",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","1","73751","ND","Individual","No","41-1242261","73751ND0080006","Medica Applause Bronze Copay (Child Only)","73751ND008",,"NDN002","NDS002","NDF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCopay","www.medica.com/IFBPharmacy","73751ND0080006-00","Standard Bronze Off Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-05","87% AV Level Silver Plan",,"0.862255096435547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080009","Medica Applause Silver  H S A","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","73751ND0080010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080009-06","94% AV Level Silver Plan",,"0.935520946979523","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$450","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-00","Standard Silver Off Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","2","73751","ND","Individual","No","41-1242261","73751ND0080010","Medica Applause Silver  H S A (Child Only)","73751ND008",,"NDN002","NDS002","NDF008","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseHSA","www.medica.com/IFBPharmacy","73751ND0080010-01","Standard Silver On Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050003","CorePlatinum","10191NJ005",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060003","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050003-01","Standard Platinum On Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050003","CorePlatinum","10191NJ005",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060003","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050003","CorePlatinum","10191NJ005",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060003","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050003-03","Limited Cost Sharing Plan Variation",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-00","Standard Silver Off Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-01","Standard Silver On Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","PrimeBronze","10191NJ003",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030001-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100001","PrimeBronze","10191NJ010",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100001-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030001","PrimeBronze","10191NJ003",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030001-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-05","87% AV Level Silver Plan",,"0.861436784267426","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140002","SolidSilver","10191NJ014",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140002-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140002-01","Standard Silver On Exchange Plan",,"0.705186069011688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","ND","93236","HIOS","2","2013-07-01 08:34:30","1","93236","ND","SHOP (Small Group)","Yes","47-0098400","93236ND0040001","EHB Low PPO","93236ND004",,"NDN001","NDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"93236ND0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","73751","HIOS","4","2013-09-02 11:39:25","3","73751","ND","Individual","No","41-1242261","73751ND0080013","Medica Applause Catastrophic","73751ND008",,"NDN002","NDS002","NDF009","New","PPO","Catastrophic","No","Both","No","No",,"Medica’s catastrophic plan will be a full family plan (“adult only”), meaning an adult policyholder is required when a dependent child under age 21 is enrolled.  However “adult and child only” is selected due to the template’s error requiring a corresponding child-only plan with an adult-only offering.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/ND_ApplauseCatastrophic","www.medica.com/IFBPharmacy","73751ND0080013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","1","75329","ND","Individual","Yes","95-6042390","75329ND0020001","BESTOne Child Dental Plus","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Child_Dental_Plus_Plan.pdf",,"75329ND0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010001","BEST Life Child Dental Plus","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Child_Dental_Plus_Plan.pdf",,"75329ND0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","1","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010001","BEST Life Child Dental Plus","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Child_Dental_Plus_Plan.pdf",,"75329ND0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","1","75329","ND","Individual","Yes","95-6042390","75329ND0020001","BESTOne Child Dental Plus","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Child_Dental_Plus_Plan.pdf",,"75329ND0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","2","75329","ND","Individual","Yes","95-6042390","75329ND0020002","BESTOne Child Dental","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Child_Dental_Plan.pdf",,"75329ND0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010002","BEST Life Child Dental","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Child_Dental_Plan.pdf",,"75329ND0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","2","75329","ND","Individual","Yes","95-6042390","75329ND0020002","BESTOne Child Dental","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Child_Dental_Plan.pdf",,"75329ND0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","2","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010002","BEST Life Child Dental","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Child_Dental_Plan.pdf",,"75329ND0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","Individual","Yes","95-6042390","75329ND0020003","BESTOne Dental Advantage - Gold","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"75329ND0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010003","BEST Dental Advantage - Gold","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Advantage_Plan_(Gold).pdf",,"75329ND0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010003","BEST Dental Advantage - Gold","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Advantage_Plan_(Gold).pdf",,"75329ND0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","Individual","Yes","95-6042390","75329ND0020003","BESTOne Dental Advantage - Gold","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"75329ND0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010004","BEST Dental Plus - Gold","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Plus_Plan_(Gold).pdf",,"75329ND0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","Individual","Yes","95-6042390","75329ND0020004","BESTOne Dental Plus - Gold","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"75329ND0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","Individual","Yes","95-6042390","75329ND0020004","BESTOne Dental Plus - Gold","75329ND002",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"75329ND0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","3","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010004","BEST Dental Plus - Gold","75329ND001",,"NDN001","NDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.67",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Plus_Plan_(Gold).pdf",,"75329ND0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","Individual","Yes","95-6042390","75329ND0020005","BESTOne Dental Plus - Silver","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"75329ND0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010005","BEST Dental Plus - Silver","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Plus_Plan_(Silver).pdf",,"75329ND0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010005","BEST Dental Plus - Silver","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Plus_Plan_(Silver).pdf",,"75329ND0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","Individual","Yes","95-6042390","75329ND0020005","BESTOne Dental Plus - Silver","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"75329ND0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","Individual","Yes","95-6042390","75329ND0020006","BESTOne Dental Basic - Silver","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Basic_Plan_Silver).pdf",,"75329ND0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010006","BEST Dental Basic - Silver","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Basic_Plan_(Silver).pdf",,"75329ND0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","SHOP (Small Group)","Yes","95-6042390","75329ND0010006","BEST Dental Basic - Silver","75329ND001",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BEST_Dental_Basic_Plan_(Silver).pdf",,"75329ND0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","75329","HIOS","8","2014-01-21 08:29:49","4","75329","ND","Individual","Yes","95-6042390","75329ND0020006","BESTOne Dental Basic - Silver","75329ND002",,"NDN001","NDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ND/pdf/ND_BESTOne_Dental_Basic_Plan_Silver).pdf",,"75329ND0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100001","Simplicity $500","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Platinum","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100001-00","Standard Platinum Off Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-06","94% AV Level Silver Plan",,"0.934350728988647","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070003","SolidGold","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070003-00","Standard Gold Off Exchange Plan",,"0.790381073951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070003","SolidGold","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070003-01","Standard Gold On Exchange Plan",,"0.790381073951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070003","SolidGold","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070003","SolidGold","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070003-03","Limited Cost Sharing Plan Variation",,"0.790381073951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-00","Standard Silver Off Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120001","CoreSilver","10191NJ012",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120001-00","Standard Silver Off Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-01","Standard Silver On Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090001","Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090001-00","Standard Gold Off Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090001","Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090001-01","Standard Gold On Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100001","Simplicity $500","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Platinum","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100001-01","Standard Platinum On Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090001","Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100002","Simplicity $1,500","89364ND010",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100002-00","Standard Gold Off Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090001","Simplicity $1,500","89364ND009",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090001-03","Limited Cost Sharing Plan Variation",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100002","Simplicity $1,500","89364ND010",,"NDN001","NDS001","NDF005","New","HMO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100002-01","Standard Gold On Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-00","Standard Silver Off Exchange Plan","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100003","Simplicity $2,500","89364ND010",,"NDN001","NDS001","NDF004","New","HMO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100003-00","Standard Silver Off Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100003","Simplicity $2,500","89364ND010",,"NDN001","NDS001","NDF004","New","HMO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100003-01","Standard Silver On Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-01","Standard Silver On Exchange Plan","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-03","Limited Cost Sharing Plan Variation",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-04","73% AV Level Silver Plan",,"0.737630486488342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-05","87% AV Level Silver Plan",,"0.863079309463501","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-06","94% AV Level Silver Plan",,"0.931904017925262","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060002","CoreGold Child Only","10191NJ006",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060002-00","Standard Gold Off Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060002","CoreGold Child Only","10191NJ006",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060002-01","Standard Gold On Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090003","Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090003-03","Limited Cost Sharing Plan Variation",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"7"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090004","Simplicity $6,350","89364ND009",,"NDN001","NDS001","NDF002","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,"8"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-05","87% AV Level Silver Plan","87.16%","0.871599018573761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,350","$12,700","$6,350","$12,700","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","1","89364","ND","Individual","No","91-1842494","89364ND0090002","Simplicity $2,500","89364ND009",,"NDN001","NDS001","NDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090002-06","94% AV Level Silver Plan","94.10%","0.940972089767456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$6,350","$12,700","$6,350","$12,700","$250","$500","20%",,,,"$500","$1,000","$500","$1,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100004","Simplicity $3,000","89364ND010",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100004-00","Standard Bronze Off Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"4"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090003","Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090003-01","Standard Bronze On Exchange Plan",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"5"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090003","Simplicity $5,000","89364ND009",,"NDN001","NDS001","NDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-05","87% AV Level Silver Plan",,"0.863079309463501","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120003","CorePlatinum","10191NJ012",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120003-01","Standard Platinum On Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-06","94% AV Level Silver Plan",,"0.931904017925262","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050002","CoreGold","10191NJ005",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050002-00","Standard Gold Off Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050002","CoreGold","10191NJ005",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050002-01","Standard Gold On Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050002","CoreGold","10191NJ005",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050002","CoreGold","10191NJ005",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050002-03","Limited Cost Sharing Plan Variation",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060001","CoreSilver Child Only","10191NJ006",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","2","89364","ND","Individual","No","91-1842494","89364ND0090004","Simplicity $6,350","89364ND009",,"NDN001","NDS001","NDF002","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/individualplans",,"www.Sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0090004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,"9"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100005","Simplicity Platinum","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Platinum","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100005-00","Standard Platinum Off Exchange Plan",,"0.885378122329712","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"4"
"2014","ND","89364","HIOS","5","2013-09-02 11:39:25","3","89364","ND","SHOP (Small Group)","No","91-1842494","89364ND0100005","Simplicity Platinum","89364ND010",,"NDN001","NDS001","NDF001","New","HMO","Platinum","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or Urgent Care Only or With Plan Certification","Yes","www.Sanfordhealthplan.com/smallgroupplans",,"www.Sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","89364ND0100005-01","Standard Platinum On Exchange Plan",,"0.885378122329712","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$1,500","$3,000","$1,500","$3,000",,,,,,,,,"5"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-00","Standard Silver Off Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100003","PrimeGold","10191NJ010",,"NJN001","NJS001","NJF006","New","EPO","Gold","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100003-01 PrimeGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100003-00","Standard Gold Off Exchange Plan",,"0.784962713718414","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0100003","PrimeGold","10191NJ010",,"NJN001","NJS001","NJF006","New","EPO","Gold","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0100003-01 PrimeGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0100003-01","Standard Gold On Exchange Plan",,"0.784962713718414","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-01","Standard Silver On Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140001","SolidBronze","10191NJ014",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140001-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140001","SolidBronze","10191NJ014",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140001-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-03","Limited Cost Sharing Plan Variation",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-04","73% AV Level Silver Plan",,"0.721072673797607","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140002","SolidSilver","10191NJ014",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140002-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140002-00","Standard Silver Off Exchange Plan",,"0.705186069011688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0030002","PrimeSilver","10191NJ003",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0030002-06","94% AV Level Silver Plan",,"0.935306787490845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140003","SolidGold","10191NJ014",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140003-00","Standard Gold Off Exchange Plan",,"0.790381073951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040001","PrimeBronze Child Only","10191NJ004",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0040001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040001-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0140003","SolidGold","10191NJ014",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0140003-01 SolidGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0140003-01","Standard Gold On Exchange Plan",,"0.790381073951721","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040001","PrimeBronze Child Only","10191NJ004",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0040001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040001-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040001","PrimeBronze Child Only","10191NJ004",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0040001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040001","PrimeBronze Child Only","10191NJ004",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0040001-01 PrimeBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040001-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-00","Standard Silver Off Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-01","Standard Silver On Exchange Plan",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-03","Limited Cost Sharing Plan Variation",,"0.686529099941254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-04","73% AV Level Silver Plan",,"0.721072673797607","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-05","87% AV Level Silver Plan",,"0.861436784267426","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0040002","PrimeSilver Child Only","10191NJ004",,"NJN001","NJS001","NJF007","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","4","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0030002-01 PrimeSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0040002-06","94% AV Level Silver Plan",,"0.935306787490845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070001","SolidBronze","10191NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070001-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070001","SolidBronze","10191NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070001-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070001","SolidBronze","10191NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070001","SolidBronze","10191NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070001-01 SolidBronze On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070001-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-00","Standard Silver Off Exchange Plan",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-01","Standard Silver On Exchange Plan",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-03","Limited Cost Sharing Plan Variation",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-04","73% AV Level Silver Plan",,"0.739748239517212","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","1","10191","NJ","Individual","No","45-3262003","10191NJ0070004","SolidSilver","10191NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0070004-01 SolidSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0070004-05","87% AV Level Silver Plan",,"0.864543795585632","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120001","CoreSilver","10191NJ012",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120001-01","Standard Silver On Exchange Plan",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120002","CoreGold","10191NJ012",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120002-00","Standard Gold Off Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120002","CoreGold","10191NJ012",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120002-01","Standard Gold On Exchange Plan",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-03","Limited Cost Sharing Plan Variation",,"0.716917991638184","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","SHOP (Small Group)","No","45-3262003","10191NJ0120003","CorePlatinum","10191NJ012",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0120003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJSHOPBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0120003-00","Standard Platinum Off Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0050001","CoreSilver","10191NJ005",,"NJN001","NJS001","NJF004","New","EPO","Silver","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Adult-Only","10191NJ0060001","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060001-01 CoreSilver I On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0050001-04","73% AV Level Silver Plan",,"0.737630486488342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060002","CoreGold Child Only","10191NJ006",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060002","CoreGold Child Only","10191NJ006",,"NJN001","NJS001","NJF010","New","EPO","Gold","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060002-01 CoreGold On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060002-03","Limited Cost Sharing Plan Variation",,"0.795261561870575","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060003","CorePlatinum Child Only","10191NJ006",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060003-00","Standard Platinum Off Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060003","CorePlatinum Child Only","10191NJ006",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060003-01","Standard Platinum On Exchange Plan",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060003","CorePlatinum Child Only","10191NJ006",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","2","10191","NJ","Individual","No","45-3262003","10191NJ0060003","CorePlatinum Child Only","10191NJ006",,"NJN001","NJS001","NJF003","New","EPO","Platinum","No","Both","No","Yes","All",,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0060003-01 CorePlatinum On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0060003-03","Limited Cost Sharing Plan Variation",,"0.882901966571808","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","3","10191","NJ","Individual","No","45-3262003","10191NJ0150001","Catastrophic Plan","10191NJ015",,"NJN001","NJS001","NJF009","New","EPO","Catastrophic","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0150001-01 Catastrophic On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0150001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","10191","HIOS","7","2014-05-02 13:10:05","3","10191","NJ","Individual","No","45-3262003","10191NJ0150001","Catastrophic Plan","10191NJ015",,"NJN001","NJS001","NJF009","New","EPO","Catastrophic","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","https://newjersey-healthrepublic-static.s3.amazonaws.com/pdf/nj/10191NJ0150001-01 Catastrophic On Exchange.pdf","http://newjersey.healthrepublic.us/contact","https://documentarchive_nj-prod.s3.amazonaws.com/archive_docs/HRINJIndivBrochure.pdf","http://newjersey.healthrepublic.us/formulary","10191NJ0150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","40704","HIOS","2","2013-07-01 08:34:30","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0040002","EHB High PPO","40704NJ004",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.64",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"40704NJ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","SHOP (Small Group)","No","22-3338404","77606NJ0050001","AmeriHealth NJ Select Local Value Silver HMO Coinsurance","77606NJ005",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","Both","Yes","Yes","Yes",,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","77606NJ0050001-00","Standard Silver Off Exchange Plan","70.19%","0.701933264732361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","$1","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-01","Standard Silver On Exchange Plan","69.62%","0.697207868099213","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","SHOP (Small Group)","No","22-3338404","77606NJ0050001","AmeriHealth NJ Select Local Value Silver HMO Coinsurance","77606NJ005",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","Both","Yes","Yes","Yes",,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","77606NJ0050001-01","Standard Silver On Exchange Plan","70.19%","0.701933264732361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","$1","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-03","Limited Cost Sharing Plan Variation","69.62%","0.697207868099213","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-04","73% AV Level Silver Plan","72.25%","0.722494661808014","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-05","87% AV Level Silver Plan","86.09%","0.860882759094238","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,600","$3,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","1","77606","NJ","Individual","No","23-2314460","77606NJ0040001","AmeriHealth NJ Select Local Value Silver HMO","77606NJ004",,"NJN002","NJS002","NJF001","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmoselvaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040001-06","94% AV Level Silver Plan","93.06%","0.930625557899475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$275","$550","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","AmeriHealth NJ  Standard Local Value Gold HMO","77606NJ004",,"NJN002","NJS002","NJF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmovaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040002-01","Standard Gold On Exchange Plan","78.04%","0.780358672142029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","2","77606","NJ","SHOP (Small Group)","No","22-3338404","77606NJ0050016","AmeriHealth NJ  Standard Local Value Gold HMO Coinsurance","77606NJ005",,"NJN002","NJS002","NJF002","New","HMO","Gold","Yes","Both","Yes","Yes","Yes",,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","77606NJ0050016-00","Standard Gold Off Exchange Plan","78.04%","0.780358552932739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","Individual","No","22-0999690","91661NJ2260002","Horizon Advance EPO Gold","91661NJ226",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Gold","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Gold","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260002-00","Standard Gold Off Exchange Plan",,"0.790709793567657","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","40%","$0","$0","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$690","$150","$1,000","$540","$210","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","Individual","Yes","22-0999690","91661NJ2310001","Horizon Young Grins","91661NJ231",,"NJN002","NJS002",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"91661NJ2310001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$675","$1,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$350","$700",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","AmeriHealth NJ  Standard Local Value Gold HMO","77606NJ004",,"NJN002","NJS002","NJF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmovaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","2","77606","NJ","SHOP (Small Group)","No","22-3338404","77606NJ0050016","AmeriHealth NJ  Standard Local Value Gold HMO Coinsurance","77606NJ005",,"NJN002","NJS002","NJF002","New","HMO","Gold","Yes","Both","Yes","Yes","Yes",,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","77606NJ0050016-01","Standard Gold On Exchange Plan","78.04%","0.780358552932739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","77606","HIOS","8","2014-01-21 08:29:49","2","77606","NJ","Individual","No","23-2314460","77606NJ0040002","AmeriHealth NJ  Standard Local Value Gold HMO","77606NJ004",,"NJN002","NJS002","NJF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Yes",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/hmovaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","77606NJ0040002-03","Limited Cost Sharing Plan Variation","78.04%","0.780358672142029","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,650","$9,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","1","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0010001","EHB Basic Dental Plan (Low)","79422NJ001","7043213272","NJN001","NJS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$10.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://qamig.eforms.metlife.com/wcm8/OIDAction.do?OID=48047",,"https://qamig.eforms.metlife.com/wcm8/OIDAction.do?OID=48046",,"79422NJ0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","1","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0010001","EHB Basic Dental Plan (Low)","79422NJ001","7043213272","NJN001","NJS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$10.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://qamig.eforms.metlife.com/wcm8/OIDAction.do?OID=48047",,"https://qamig.eforms.metlife.com/wcm8/OIDAction.do?OID=48046",,"79422NJ0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","2","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0020001","EHB Enhanced Dental Plan (High)","79422NJ002","7043213272","NJN002","NJS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$11.86",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49108",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49107",,"79422NJ0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020001",,"48608NJ0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","Individual","Yes","75-1233841","48608NJ0010001","Dentegra Dental PPO Children's Plan 70","48608NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010001",,"48608NJ0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020001",,"48608NJ0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020002",,"48608NJ0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","Individual","Yes","75-1233841","48608NJ0010002","Dentegra Dental PPO Children's Plan 85","48608NJ001",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.16",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010002",,"48608NJ0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","Individual","Yes","75-1233841","48608NJ0010002","Dentegra Dental PPO Children's Plan 85","48608NJ001",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.16",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010002",,"48608NJ0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020002",,"48608NJ0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","2","48608","NJ","Individual","Yes","75-1233841","48608NJ0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","48608NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010006",,"48608NJ0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","2","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020006",,"48608NJ0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","2","48608","NJ","Individual","Yes","75-1233841","48608NJ0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","48608NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010006",,"48608NJ0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","2","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020006",,"48608NJ0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","3","48608","NJ","Individual","Yes","75-1233841","48608NJ0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","48608NJ001",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.16",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010004",,"48608NJ0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","3","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020004",,"48608NJ0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","3","48608","NJ","SHOP (Small Group)","Yes","75-1233841","48608NJ0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","48608NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/nj/48608nj0020004",,"48608NJ0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","3","48608","NJ","Individual","Yes","75-1233841","48608NJ0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","48608NJ001",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.16",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010004",,"48608NJ0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","2","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0020001","EHB Enhanced Dental Plan (High)","79422NJ002","7043213272","NJN002","NJS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$11.86",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49108",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49107",,"79422NJ0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","4","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004","7043213272","NJN004","NJS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$11.86",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111",,"79422NJ0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-05","87% AV Level Silver Plan",,"0.867401957511902","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,000","$2,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$400","$150","$500","$0","$460","$80","9"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-06","94% AV Level Silver Plan",,"0.936362385749817","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$500","$1,000","$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$500","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$450","$150","$0","$0","$500","$80","10"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","3","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270002-00","Standard Bronze Off Exchange Plan",,"0.617939233779907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$150","$2,500","$0","$1,320","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","3","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270002-01","Standard Bronze On Exchange Plan",,"0.617939233779907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$1,000","$150","$2,500","$0","$1,320","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","3","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$2,040","$150","$2,500","$0","$1,320","$80","6"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","3","91661","NJ","Individual","No","22-0999690","91661NJ2270002","Horizon Advantage EPO Bronze","91661NJ227",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270002-03","Limited Cost Sharing Plan Variation",,"0.617939233779907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$2,040","$150","$2,500","$0","$1,320","$80","7"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","4","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $20/$40","91661NJ230",,"NJN001","NJS001","NJF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-20-40","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-20-40","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300001-00","Standard Gold Off Exchange Plan","81.90%","0.819029688835144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$320","$0","$150","$0","$800","$640","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","4","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300001","Advantage EPO Gold 100  $20/$40","91661NJ230",,"NJN001","NJS001","NJF008","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-20-40","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-20-40","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300001-01","Standard Gold On Exchange Plan","81.90%","0.819029688835144","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$320","$0","$150","$0","$800","$640","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-00","Standard Silver Off Exchange Plan",,"0.695204973220825","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$990","$150","$2,000","$620","$350","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF007","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-80","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-80","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300003-00","Standard Gold Off Exchange Plan",,"0.786284148693085","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$690","$150","$770","$480","$520","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300003","Advantage EPO Gold 100/80","91661NJ230",,"NJN001","NJS001","NJF007","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-80","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-80","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300003-01","Standard Gold On Exchange Plan",,"0.786284148693085","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$690","$150","$770","$480","$520","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-01","Standard Silver On Exchange Plan",,"0.695204973220825","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$990","$150","$2,000","$620","$350","$80","5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","AmeriHealth NJ Premium Local Value Bronze HSA EPO","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070001-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080001","AmeriHealth NJ Premium Local Value HSA Bronze EPO","91762NJ008",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080001-00","Standard Bronze Off Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","2","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0200001","EHB Enhanced Dental Plan (High)","53877NJ020","7326041556","NJN002","NJS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$32.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49102",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49101",,"53877NJ0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","2","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0200001","EHB Enhanced Dental Plan (High)","53877NJ020","7326041556","NJN002","NJS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$32.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49102",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49101",,"53877NJ0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","3","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021","7326041556","NJN003","NJS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103",,"53877NJ0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","40704","HIOS","2","2013-07-01 08:34:30","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0040001","EHB Low PPO","40704NJ004",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"40704NJ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","40704","HIOS","2","2013-07-01 08:34:30","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0030002","EHB High Passive","40704NJ003",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$52.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"40704NJ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","40704","HIOS","2","2013-07-01 08:34:30","1","40704","NJ","SHOP (Small Group)","Yes","47-0098400","40704NJ0030001","EHB Low Passive","40704NJ003",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.32",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"40704NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-06","94% AV Level Silver Plan","93.16%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$550","$1,100",,,"$12,800","$25,600","Not Applicable","Not Applicable","$225","$450","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","4","91762","NJ","Individual","No","22-3338404","91762NJ0070011","AmeriHealth NJ Premium National Access Gold POS+","91762NJ007",,"NJN003","NJS001","NJF003","New","POS","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","National Access","Yes","www.amerihealth.com/ffm/pospremnationalgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070011-01","Standard Gold On Exchange Plan","81.00%","0.810015797615051","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","AmeriHealth NJ Premium Local Value Bronze HSA EPO","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080001","AmeriHealth NJ Premium Local Value HSA Bronze EPO","91762NJ008",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080001-01","Standard Bronze On Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080002","AmeriHealth NJ Premium Regional Preferred HSA Bronze EPO","91762NJ008",,"NJN001","NJS001","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080002-00","Standard Bronze Off Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070001","AmeriHealth NJ Premium Local Value Bronze HSA EPO","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070001-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","AmeriHealth NJ Premium Regional Preferred Bronze HSA EPO","91762NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070002-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","4","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0040001","Family Enhanced Dental Plan (High)","79422NJ004","7043213272","NJN004","NJS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$11.86",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49112",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49111",,"79422NJ0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-04","73% AV Level Silver Plan",,"0.72064483165741","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$50","$1,790","$150","$2,000","$620","$350","$80","8"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-05","87% AV Level Silver Plan",,"0.862458944320679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$10","$740","$150","$750","$360","$210","$80","9"
"2014","NJ","51791","HIOS","2","2013-07-01 08:34:30","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0030001","EHB Low Passive","51791NJ003",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.92",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"51791NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","1","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0230001","EHB Basic Dental Plan (Low)","53877NJ023","7326041556","NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48049",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48048",,"53877NJ0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","1","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0230001","EHB Basic Dental Plan (Low)","53877NJ023","7326041556","NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48049",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48048",,"53877NJ0230001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0020001","Managed DentalGuard NJ Child Essentials 1","44811NJ002",,"NJN001","NJS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0020001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0020001","Managed DentalGuard NJ Child Essentials 1","44811NJ002",,"NJN001","NJS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0020001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0010001","Managed DentalGuard NJ Child Essentials 2","44811NJ001",,"NJN001","NJS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0010001-00","Standard High Off Exchange Plan","83.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","1","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0010001","Managed DentalGuard NJ Child Essentials 2","44811NJ001",,"NJN001","NJS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0010001-01","Standard High On Exchange Plan","83.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","2","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0050001","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0050001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","2","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0050001","Managed DentalGuard NJ 10 Family Plan","44811NJ005",,"NJN001","NJS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0050001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","2","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0070001","Managed DentalGuard NJ 20 Family Plan","44811NJ007",,"NJN001","NJS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0070001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","44811","HIOS","4","2013-09-02 11:39:25","2","44811","NJ","SHOP (Small Group)","Yes","22-3849572","44811NJ0080001","Managed DentalGuard NJ 30 Family Plan","44811NJ008",,"NJN001","NJS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,,,"44811NJ0080001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","48608","HIOS","8","2014-01-17 09:36:20","1","48608","NJ","Individual","Yes","75-1233841","48608NJ0010001","Dentegra Dental PPO Children's Plan 70","48608NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/nj/48608nj0010001",,"48608NJ0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","51791","HIOS","2","2013-07-01 08:34:30","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0040002","EHB High PPO","51791NJ004",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"51791NJ0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","51791","HIOS","2","2013-07-01 08:34:30","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0040001","EHB Low PPO","51791NJ004",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.68",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"51791NJ0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","51791","HIOS","2","2013-07-01 08:34:30","1","51791","NJ","SHOP (Small Group)","Yes","93-0242990","51791NJ0030002","EHB High Passive","51791NJ003",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.68",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas’ online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on “Find a Provider.”","Yes","www.standard.com","www.standard.com","www.standard.com",,"51791NJ0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","7","91762","NJ","Individual","No","22-3338404","91762NJ0070004","AmeriHealth NJ Tier 1 Advantage�Bronze EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsatier1advantagebronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","7","91762","NJ","Individual","No","22-3338404","91762NJ0070004","AmeriHealth NJ Tier 1 Advantage�Bronze EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsatier1advantagebronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070004-03","Limited Cost Sharing Plan Variation","61.99%","0.619938910007477","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%","$2,350","$4,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","8","91762","NJ","Individual","No","22-3338404","91762NJ0070010","AmeriHealth NJ Standard Regional Preferred Gold EPO","91762NJ007",,"NJN001","NJS001","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epopremregionalprefgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070010-01","Standard Gold On Exchange Plan","78.13%","0.781319141387939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","8","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080004","AmeriHealth NJ Tier 1 Advantage�Bronze EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080004-00","Standard Bronze Off Exchange Plan","61.99%","0.619938910007477","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%","$2,350","$4,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","8","91762","NJ","Individual","No","22-3338404","91762NJ0070010","AmeriHealth NJ Standard Regional Preferred Gold EPO","91762NJ007",,"NJN001","NJS001","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epopremregionalprefgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","8","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080004","AmeriHealth NJ Tier 1 Advantage�Bronze EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080004-01","Standard Bronze On Exchange Plan","61.99%","0.619938910007477","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%","$2,350","$4,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","8","91762","NJ","Individual","No","22-3338404","91762NJ0070010","AmeriHealth NJ Standard Regional Preferred Gold EPO","91762NJ007",,"NJN001","NJS001","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epopremregionalprefgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070010-03","Limited Cost Sharing Plan Variation","78.13%","0.781319141387939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","9","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080018","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080018-00","Standard Silver Off Exchange Plan","68.05%","0.68046498298645","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,100","$10,200","$5,100","$10,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","50%","$1,350","$2,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","Individual","Yes","23-1661402","97057NJ0020001","Smile for Health Child C60A60","97057NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","Individual","Yes","23-1661402","97057NJ0020001","Smile for Health Child C60A60","97057NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0100001","Smile for Health Child C60A60","97057NJ010",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a60-ppo.pdf",,,,"97057NJ0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020001",,"45689OK0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","Individual","Yes","75-1233841","45689OK0010001","Dentegra Dental PPO Children's Plan 70","45689OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.23",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010001",,"45689OK0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020001",,"45689OK0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","Individual","Yes","75-1233841","45689OK0010001","Dentegra Dental PPO Children's Plan 70","45689OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.23",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010001",,"45689OK0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020002",,"45689OK0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","Individual","Yes","75-1233841","45689OK0010002","Dentegra Dental PPO Children's Plan 85","45689OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010002",,"45689OK0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","3","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0210001","Family Basic Dental Plan (Low)","53877NJ021","7326041556","NJN003","NJS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49104",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49103",,"53877NJ0210001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","4","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022","7326041556","NJN004","NJS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$32.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105",,"53877NJ0220001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","53877","HIOS","6","2013-10-15 07:27:56","4","53877","NJ","SHOP (Small Group)","Yes","13-5581829","53877NJ0220001","Family Enhanced Dental Plan (High)","53877NJ022","7326041556","NJN004","NJS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$32.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49106",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49105",,"53877NJ0220001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","3","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003","7043213272","NJN003","NJS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109",,"79422NJ0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","79422","HIOS","6","2013-10-15 07:27:56","3","79422","NJ","SHOP (Small Group)","Yes","33-0733552","79422NJ0030001","Family Basic Dental Plan (Low)","79422NJ003","7043213272","NJN003","NJS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","No","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49110",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49109",,"79422NJ0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF008","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Offers out of network coverage","Yes","http://horizonblue.com/SBC-Advantage-Direct-Access-100-80-60","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-Direct-Access-100-80-60","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2290002-00","Standard Gold Off Exchange Plan",,"0.786255776882172","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,500","$20","$590","$150","$1,130","$600","$450","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","SHOP (Small Group)","Yes","22-0999690","91661NJ2330001","Horizon Young Grins","91661NJ233",,"NJN002","NJS002",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"91661NJ2330001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$675","$1,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$350","$700",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","Individual","No","22-0999690","91661NJ2260002","Horizon Advance EPO Gold","91661NJ226",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Gold","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Gold","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260002-01","Standard Gold On Exchange Plan",,"0.790709793567657","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","40%","$0","$0","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$690","$150","$1,000","$540","$210","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2290002","Direct Access Gold 100/80/60 BlueCard","91661NJ229",,"NJN001","NJS001","NJF008","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Offers out of network coverage","Yes","http://horizonblue.com/SBC-Advantage-Direct-Access-100-80-60","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-Direct-Access-100-80-60","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2290002-01","Standard Gold On Exchange Plan",,"0.786255776882172","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,500","$20","$590","$150","$1,130","$600","$450","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","Individual","No","22-0999690","91661NJ2260002","Horizon Advance EPO Gold","91661NJ226",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Gold","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Gold","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$690","$150","$1,000","$540","$210","$80","6"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","1","91661","NJ","Individual","No","22-0999690","91661NJ2260002","Horizon Advance EPO Gold","91661NJ226",,"NJN001","NJS001","NJF002","New","EPO","Gold","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Gold","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Gold","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260002-03","Limited Cost Sharing Plan Variation",,"0.790709793567657","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","40%","$0","$0","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$690","$150","$1,000","$540","$210","$80","7"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","SHOP (Small Group)","Yes","22-0999690","91661NJ2320001","Horizon Young Grins Plus","91661NJ232",,"NJN002","NJS002",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.20",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Offers out of network coverage","No",,,,,"91661NJ2320001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$150",,,,,"$350","$700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-00","Standard Silver Off Exchange Plan",,"0.687298715114594","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,500","$5,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$900","$150","$1,500","$0","$1,090","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-01","Standard Silver On Exchange Plan",,"0.687298715114594","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,500","$5,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$900","$150","$1,500","$0","$1,090","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$890","$150","$1,500","$400","$410","$80","6"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-03","Limited Cost Sharing Plan Variation",,"0.687298715114594","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,500","$5,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$890","$150","$1,500","$400","$410","$80","7"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","2","91661","NJ","Individual","No","22-0999690","91661NJ2260003","Horizon Advance EPO Silver","91661NJ226",,"NJN001","NJS001","NJF003","New","EPO","Silver","No","Both","No","Yes","Any non-Primary Care Provider",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advance-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advance-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2260003-04","73% AV Level Silver Plan",,"0.72899204492569","Yes","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$4,500","$9,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$900","$150","$1,500","$0","$1,090","$80","8"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$2,040","$150","$2,500","$0","$1,320","$80","6"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-03","Limited Cost Sharing Plan Variation",,"0.695204973220825","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$2,040","$150","$2,500","$0","$1,320","$80","7"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","6","91661","NJ","Individual","No","22-0999690","91661NJ2270001","Horizon Advantage EPO Silver","91661NJ227",,"NJN001","NJS001","NJF005","New","EPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2270001-06","94% AV Level Silver Plan",,"0.930130481719971","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$40","$450","$150","$0","$400","$130","$80","10"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","7","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF008","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-70","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-70","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300004-00","Standard Silver Off Exchange Plan",,"0.714488804340363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$890","$150","$1,120","$680","$450","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","7","91661","NJ","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF004","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Catastrophic","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Catastrophic","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2280001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,130","$0","$0","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","7","91661","NJ","Individual","No","22-0999690","91661NJ2280001","Horizon Advantage EPO Essentials","91661NJ228",,"NJN001","NJS001","NJF004","New","EPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-Catastrophic","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-Catastrophic","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2280001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,130","$0","$0","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","7","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300004","Advantage EPO Silver 100/70","91661NJ230",,"NJN001","NJS001","NJF008","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-70","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-70","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300004-01","Standard Silver On Exchange Plan",,"0.714488804340363","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$890","$150","$1,120","$680","$450","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","10","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-30-50-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-30-50-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300007-00","Standard Bronze Off Exchange Plan",,"0.615084111690521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$500","$10","$150","$2,000","$230","$1,420","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","10","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300007","Advantage EPO HSA Bronze 100 Compatible","91661NJ230",,"NJN001","NJS001","NJF006","New","EPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-30-50-Bronze","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-30-50-Bronze","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300007-01","Standard Bronze On Exchange Plan",,"0.615084111690521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$500","$10","$150","$2,000","$230","$1,420","$80","5"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","22","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300015","Advantage EPO HSA Silver 100 Compatible $750 Contrib.","91661NJ230",,"NJN001","NJS001","NJF006","New","EPO","Silver","No","Both","No","No",,,,"Yes","Yes","$750.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-30-50-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-30-50-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300015-00","Standard Silver Off Exchange Plan",,"0.702476322650909","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$500","$10","$150","$2,000","$230","$1,420","$80","4"
"2014","NJ","91661","HIOS","11","2014-07-25 16:54:18","22","91661","NJ","SHOP (Small Group)","No","22-0999690","91661NJ2300015","Advantage EPO HSA Silver 100 Compatible $750 Contrib.","91661NJ230",,"NJN001","NJS001","NJF006","New","EPO","Silver","No","Both","No","No",,,,"Yes","Yes","$750.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"5","0","0","2014-01-01",,"No",,"No",,"No","http://horizonblue.com/SBC-Advantage-EPO-100-30-50-Silver","https://secure.horizonblue.com/FedSP/sp/ACS.saml2","http://horizonblue.com/Brochure-Advantage-EPO-100-30-50-Silver","https://myprime.com/MyRx/MyPrime/Commercial/findDrugs/NJBCBS/181#!/ViewFindDrugsEvent","91661NJ2300015-01","Standard Silver On Exchange Plan",,"0.702476322650909","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$500","$10","$150","$2,000","$230","$1,420","$80","5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080002","AmeriHealth NJ Premium Regional Preferred HSA Bronze EPO","91762NJ008",,"NJN001","NJS001","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080002-01","Standard Bronze On Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","7","91762","NJ","Individual","No","22-3338404","91762NJ0070004","AmeriHealth NJ Tier 1 Advantage�Bronze EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsatier1advantagebronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070004-01","Standard Bronze On Exchange Plan","61.99%","0.619938910007477","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%","$2,350","$4,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","Individual","Yes","23-1661402","97057NJ0070002","Smile for Health Family C80A80","97057NJ007",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$50.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140009","Delta Dental PPO plus Premier - Basic POS Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$50.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140009-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130015","Delta Dental PPO - Enhanced POS Family Plan","99708NJ013",,"NJN001","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130015-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130016","Delta Dental PPO - Basic POS Family Plan","99708NJ013",,"NJN001","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.67",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130016-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140008","Delta Dental PPO - Enhanced POS+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140008-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"16"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-03","Limited Cost Sharing Plan Variation","71.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-04","73% AV Level Silver Plan","73.53%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,150","$10,300",,,"$12,800","$25,600","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-05","87% AV Level Silver Plan","86.01%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$12,800","$25,600","Not Applicable","Not Applicable","$400","$800","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0040001","Guardian Family Advantage Plus","93627NJ004",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0040001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","2","93627","NJ","Individual","Yes","13-5123390","93627NJ0110001","Guardian Family Advantage","93627NJ011",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$46.12",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes",,,,,"93627NJ0110001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","2","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0040001","Guardian Family Advantage Plus","93627NJ004",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0040001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","2","93627","NJ","Individual","Yes","13-5123390","93627NJ0130001","Guardian Family Essentials","93627NJ013",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.42",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes",,,,,"93627NJ0130001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","3","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0060001","Guardian Family Essentials Plus","93627NJ006",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0060001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","7","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080036","AmeriHealth NJ Standard National Access Platinum POS Plus","91762NJ008",,"NJN003","NJS001","NJF004","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080036-01","Standard Platinum On Exchange Plan","88.06%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$2,700","$0","$0","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","3","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0060001","Guardian Family Essentials Plus","93627NJ006",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0060001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-03","Limited Cost Sharing Plan Variation","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","AmeriHealth NJ Premium Regional Preferred Bronze HSA EPO","91762NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080003"," AmeriHealth NJ Premium National Access HSA Bronze EPO","91762NJ008",,"NJN003","NJS001","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080003-00","Standard Bronze Off Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070002","AmeriHealth NJ Premium Regional Preferred Bronze HSA EPO","91762NJ007",,"NJN001","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070002-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080003"," AmeriHealth NJ Premium National Access HSA Bronze EPO","91762NJ008",,"NJN003","NJS001","NJF001","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080003-01","Standard Bronze On Exchange Plan","61.94%","0.619375944137573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","AmeriHealth NJ Premium National Access Bronze HSA EPO","91762NJ007",,"NJN003","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070003-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","AmeriHealth NJ Premium National Access Bronze HSA EPO","91762NJ007",,"NJN003","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","1","91762","NJ","Individual","No","22-3338404","91762NJ0070003","AmeriHealth NJ Premium National Access Bronze HSA EPO","91762NJ007",,"NJN003","NJS001","NJF001","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/epo_v_p_n_bronze","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070003-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080010","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080010-00","Standard Silver Off Exchange Plan","71.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-01","Standard Silver On Exchange Plan","71.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080010","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ008",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080010-01","Standard Silver On Exchange Plan","71.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-03","Limited Cost Sharing Plan Variation","71.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-04","73% AV Level Silver Plan","73.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-05","87% AV Level Silver Plan","86.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$900","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","2","91762","NJ","Individual","No","22-3338404","91762NJ0070005","AmeriHealth NJ Premium Regional Preferred Silver EPO","91762NJ007",,"NJN001","NJS001","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epopremregionalprefsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070005-06","94% AV Level Silver Plan","93.1%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080017","AmeriHealth NJ Premium National Access Silver POS Plus","91762NJ008",,"NJN003","NJS001","NJF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080017-00","Standard Silver Off Exchange Plan","71.69%","0.716908633708954","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080008","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080008-01","Standard Silver On Exchange Plan","68.98%","0.689814388751984","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-03","Limited Cost Sharing Plan Variation","71.83%","0.718328416347504","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-04","73% AV Level Silver Plan","74.00%","0.739995837211609","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-05","87% AV Level Silver Plan","86.01%","0.860110402107239","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","50%","$350","$700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-06","94% AV Level Silver Plan","93.02%","0.930150926113129","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","50%","$100","$200","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-01","Standard Silver On Exchange Plan","68.05%","0.68046498298645","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,100","$10,200","$5,100","$10,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","50%","$1,350","$2,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","Individual","No","22-3338404","91762NJ0070009","AmeriHealth NJ Premium National Access Silver POS+","91762NJ007",,"NJN003","NJS001","NJF002","New","POS","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/pospremnationalsilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070009-01","Standard Silver On Exchange Plan","71.52%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","3","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080017","AmeriHealth NJ Premium National Access Silver POS Plus","91762NJ008",,"NJN003","NJS001","NJF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080017-01","Standard Silver On Exchange Plan","71.69%","0.716908633708954","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0020001","Guardian Pediatric Advantage","93627NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0020001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","Individual","Yes","13-5123390","93627NJ0080001","Guardian Pediatric Advantage","93627NJ008",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$46.12",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"93627NJ0080001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","Individual","Yes","13-5123390","93627NJ0090001","Guardian Pediatric Essentials","93627NJ009",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.42",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"93627NJ0090001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","Individual","Yes","23-1661402","97057NJ0070001","Smile for Health Child C80A80","97057NJ007",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$50.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0150001","Smile for Health Child C80A80","97057NJ015",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c80a80-ppo.pdf",,,,"97057NJ0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010004","BEST Dental Plus - Gold","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Plus_Plan_(Gold).pdf",,"40254OK0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010004","BEST Dental Plus - Gold","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Plus_Plan_(Gold).pdf",,"40254OK0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","Individual","Yes","95-6042390","40254OK0020004","BESTOne Dental Plus - Gold","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"40254OK0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010005","BEST Dental Plus - Silver","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Plus_Plan_(Silver).pdf",,"40254OK0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","2","45689","OK","Individual","Yes","75-1233841","45689OK0010006","Dentegra Dental PPO Children's Plan 70 +Basic for Adults","45689OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.23",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010006",,"45689OK0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","2","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020006","Dentegra Dental PPO Children's Plan 70 +Basic for Adults for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020006",,"45689OK0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","2","45689","OK","Individual","Yes","75-1233841","45689OK0010006","Dentegra Dental PPO Children's Plan 70 +Basic for Adults","45689OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.23",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010006",,"45689OK0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","2","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020006","Dentegra Dental PPO Children's Plan 70 +Basic for Adults for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020006",,"45689OK0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$19,050","$38,100","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$19,050","$38,100","Not Applicable","Not Applicable","$150","$300","10%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$19,050","$38,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","4","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080023","AmeriHealth NJ Standard Regional Preferred Gold EPO","91762NJ008",,"NJN001","NJS001","NJF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080023-00","Standard Gold Off Exchange Plan","78.13%","0.781319141387939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","4","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080023","AmeriHealth NJ Standard Regional Preferred Gold EPO","91762NJ008",,"NJN001","NJS001","NJF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080023-01","Standard Gold On Exchange Plan","78.13%","0.781319141387939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$19,050","$38,100","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","6","66946","OK","Individual","No","06-6033492","66946OK0080009","Aetna Classic 5000","66946OK008",,"OKN001","OKS001","OKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080009-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$19,050","$38,100","Not Applicable","Not Applicable","$150","$300","10%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","Individual","Yes","23-1661402","97057NJ0070002","Smile for Health Family C80A80","97057NJ007",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$50.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0150002","Smile for Health Family C80A80","97057NJ015",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c80a80-ppo.pdf",,,,"97057NJ0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","Individual","Yes","95-6042390","40254OK0020005","BESTOne Dental Plus - Silver","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"40254OK0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","Individual","Yes","95-6042390","40254OK0020005","BESTOne Dental Plus - Silver","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"40254OK0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010005","BEST Dental Plus - Silver","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Plus_Plan_(Silver).pdf",,"40254OK0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010006","BEST Dental Basic - Silver","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Basic_Plan_(Silver).pdf",,"40254OK0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","Individual","Yes","95-6042390","40254OK0020006","BESTOne Dental Basic - Silver","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"40254OK0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010006","BEST Dental Basic - Silver","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Basic_Plan_(Silver).pdf",,"40254OK0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","4","40254","OK","Individual","Yes","95-6042390","40254OK0020006","BESTOne Dental Basic - Silver","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"40254OK0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","Individual","Yes","75-1233841","45689OK0010002","Dentegra Dental PPO Children's Plan 85","45689OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010002",,"45689OK0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","1","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020002",,"45689OK0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","7","97057","NJ","Individual","Yes","23-1661402","97057NJ0230001","Smile for Health Child C40","97057NJ023",,"NJN001","NJS001",,"New","Indemnity","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0230001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","Individual","Yes","23-1661402","97057NJ0010002","Smile for Health Family C60A70","97057NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0090002","Smile for Health Family C60A70","97057NJ009",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a70-ppo.pdf",,,,"97057NJ0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0090001","Smile for Health Child C60A70","97057NJ009",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a70-ppo.pdf",,,,"97057NJ0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0040004","Bronze Deductible Only HSA Eligible HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72506","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","5","76668","OK","Individual","No","48-0840330","76668OK0040001","Gold $5 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72501","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","5","76668","OK","Individual","No","48-0840330","76668OK0040001","Gold $5 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72501","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","5","76668","OK","Individual","No","48-0840330","76668OK0040001","Gold $5 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72501","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","1","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020001","PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,"6 month wait on Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$39.31",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0020001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","1","77760","OK","Individual","Yes","23-7322578","77760OK0010001","PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,"6 month wait on Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$40.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0010001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","2","77760","OK","Individual","Yes","23-7322578","77760OK0010002","PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,"6 month wait of Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0010002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","3","53524","OK","Individual","No","75-1296086","53524OK0050003","Bronze $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72518","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","3","53524","OK","Individual","No","75-1296086","53524OK0050003","Bronze $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72518","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","4","91762","NJ","Individual","No","22-3338404","91762NJ0070011","AmeriHealth NJ Premium National Access Gold POS+","91762NJ007",,"NJN003","NJS001","NJF003","New","POS","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","National Access","Yes","www.amerihealth.com/ffm/pospremnationalgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","4","91762","NJ","Individual","No","22-3338404","91762NJ0070011","AmeriHealth NJ Premium National Access Gold POS+","91762NJ007",,"NJN003","NJS001","NJF003","New","POS","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","National Access","Yes","www.amerihealth.com/ffm/pospremnationalgold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070011-03","Limited Cost Sharing Plan Variation","81.00%","0.810015797615051","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","5","91762","NJ","Individual","No","22-3338404","91762NJ0070013","AmeriHealth NJ Select National Access Platinum POS+","91762NJ007",,"NJN003","NJS001","NJF004","New","POS","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"5","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/posselnationalplatinum","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070013-01","Standard Platinum On Exchange Plan","89.7%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","5","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080024","AmeriHealth NJ  Standard Local Value Gold EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080024-00","Standard Gold Off Exchange Plan","78.02%","0.78018319606781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","5","91762","NJ","Individual","No","22-3338404","91762NJ0070013","AmeriHealth NJ Select National Access Platinum POS+","91762NJ007",,"NJN003","NJS001","NJF004","New","POS","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"5","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/posselnationalplatinum","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","5","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080024","AmeriHealth NJ  Standard Local Value Gold EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080024-01","Standard Gold On Exchange Plan","78.02%","0.78018319606781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","5","91762","NJ","Individual","No","22-3338404","91762NJ0070013","AmeriHealth NJ Select National Access Platinum POS+","91762NJ007",,"NJN003","NJS001","NJF004","New","POS","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"5","0","0","2014-01-01",,"No",,"No",,"Yes","www.amerihealth.com/ffm/posselnationalplatinum","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070013-03","Limited Cost Sharing Plan Variation","89.7%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","6","91762","NJ","Individual","No","22-3338404","91762NJ0070014","AmeriHealth NJ Simple Saver Local Value","91762NJ007",,"NJN002","NJS002","NJF005","New","EPO","Catastrophic","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","3","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/simplesaverlocalvalue","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","6","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080032"," AmeriHealth NJ Premium National Access Gold POS Plus","91762NJ008",,"NJN003","NJS001","NJF003","New","POS","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080032-00","Standard Gold Off Exchange Plan","81.83%","0.818338215351105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","6","91762","NJ","Individual","No","22-3338404","91762NJ0070015","AmeriHealth NJ Simple Saver Regional Preferred","91762NJ007",,"NJN001","NJS001","NJF005","New","EPO","Catastrophic","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","3","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/simplesaverlocalvalue","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070015-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","6","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080032"," AmeriHealth NJ Premium National Access Gold POS Plus","91762NJ008",,"NJN003","NJS001","NJF003","New","POS","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080032-01","Standard Gold On Exchange Plan","81.83%","0.818338215351105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","7","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080036","AmeriHealth NJ Standard National Access Platinum POS Plus","91762NJ008",,"NJN003","NJS001","NJF004","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,,"5","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","Yes","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080036-00","Standard Platinum Off Exchange Plan","88.06%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$2,700","$0","$0","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","12","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0160002","Smile for Health Family C80A50","97057NJ016",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120001","Delta Dental Individual-Basic Pediatric EPO Essential Health Benefit","99708NJ012",,"NJN001","NJS001",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$55.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalcoversme.com","https://auth.deltadentalcoversme.com/sp/startSSO.ping?PartnerIdpId=deltadentalcoversme:saml2","http://deltadentalcoversme.com",,"99708NJ0120001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","9","91762","NJ","Individual","No","22-3338404","91762NJ0070012","AmeriHealth NJ  Standard Local Value Gold EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsavaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070012-01","Standard Gold On Exchange Plan","78.02%","0.78018319606781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","9","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080018","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080018-01","Standard Silver On Exchange Plan","68.05%","0.68046498298645","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,100","$10,200","$5,100","$10,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","50%","$1,350","$2,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","9","91762","NJ","Individual","No","22-3338404","91762NJ0070012","AmeriHealth NJ  Standard Local Value Gold EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsavaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","9","91762","NJ","Individual","No","22-3338404","91762NJ0070012","AmeriHealth NJ  Standard Local Value Gold EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF004","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Care is covered outside of the service area.","No","www.amerihealth.com/ffm/epohsavaluegold","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070012-03","Limited Cost Sharing Plan Variation","78.02%","0.78018319606781","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080019","Cooper Advantage Silver EPO","91762NJ008",,"NJN002","NJS003","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080019-00","Standard Silver Off Exchange Plan","71.89%","0.718929529190063","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-01","Standard Silver On Exchange Plan","68.98%","0.689814388751984","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080019","Cooper Advantage Silver EPO","91762NJ008",,"NJN002","NJS003","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","0","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080019-01","Standard Silver On Exchange Plan","71.89%","0.718929529190063","No","Yes","Yes","55%","45%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-03","Limited Cost Sharing Plan Variation","68.98%","0.689814388751984","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-04","73% AV Level Silver Plan","72.77%","0.727681994438171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-05","87% AV Level Silver Plan","86.61%","0.866135597229004","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","10","91762","NJ","Individual","No","22-3338404","91762NJ0070006","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epohsavaluesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070006-06","94% AV Level Silver Plan","93.76%","0.937573373317719","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","Individual","No","22-3338404","91762NJ0070008","Cooper Advantage Silver EPO","91762NJ007",,"NJN002","NJS003","NJF003","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","0","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/epocooperadvantagesliver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070008-01","Standard Silver On Exchange Plan","71.83%","0.718328416347504","No","Yes","Yes","54%","46%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%","$2,000","$4,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","11","91762","NJ","SHOP (Small Group)","No","22-3338404","91762NJ0080008","AmeriHealth NJ  Standard Local Value Silver EPO H.S.A.","91762NJ008",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.999",,"$125","5","0","0","2014-01-01",,"No",,"Yes","Emergency coverage only","No","www.amerihealth.com/ffm/shop","www.amerihealthnj.com/market/SHOP","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0080008-00","Standard Silver Off Exchange Plan","68.98%","0.689814388751984","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-03","Limited Cost Sharing Plan Variation","68.05%","0.68046498298645","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,100","$10,200","$5,100","$10,200","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","50%","$1,350","$2,700","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-04","73% AV Level Silver Plan","72.15%","0.72147810459137","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$3,850","$7,700","$3,850","$7,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","50%","$1,250","$2,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-05","87% AV Level Silver Plan","86.02%","0.86016970872879","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,550","$3,100","$1,550","$3,100","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","50%","$300","$600","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NJ","91762","HIOS","9","2013-11-26 13:14:08","12","91762","NJ","Individual","No","22-3338404","91762NJ0070007","AmeriHealth NJ Tier 1 Advantage�Silver EPO H.S.A.","91762NJ007",,"NJN002","NJS002","NJF002","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"0.9994",,"$125","5","0","0","2014-01-01",,"No",,"No",,"No","www.amerihealth.com/ffm/epohsatier1advantagesilver","apply.ahnj4you.com/amerihealth/payment/PaymentPortalStart.action","www.amerihealth.com/ffm/shop/brochure","www.amerihealth.com/ffm/formulary","91762NJ0070007-06","94% AV Level Silver Plan","93.00%","0.930007040500641","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","50%","$100","$200","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0020001","Guardian Pediatric Advantage","93627NJ002",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0020001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0030001","Guardian Pediatric Essentials","93627NJ003",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0030001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","1","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0030001","Guardian Pediatric Essentials","93627NJ003",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0030001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","4","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0050001","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0050001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","4","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0050001","Guardian Family Advantage","93627NJ005",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0050001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","4","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0070001","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0070001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","93627","HIOS","4","2013-09-02 11:39:25","4","93627","NJ","SHOP (Small Group)","Yes","13-5123390","93627NJ0070001","Guardian Family Essentials","93627NJ007",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is availible outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"93627NJ0070001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","Individual","Yes","23-1661402","97057NJ0010002","Smile for Health Family C60A70","97057NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0090002","Smile for Health Family C60A70","97057NJ009",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a70-ppo.pdf",,,,"97057NJ0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140007","Delta Dental PPO - Basic POS+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.32",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140007-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"17"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140012","Delta Dental PPO plus Premier - Enhanced POS+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140012-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"18"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140011","Delta Dental PPO plus Premier - Basic POS+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.83",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140011-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"19"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0150002","Smile for Health Family C80A80","97057NJ015",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c80a80-ppo.pdf",,,,"97057NJ0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","Individual","Yes","95-6042390","40254OK0020004","BESTOne Dental Plus - Gold","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"40254OK0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","8","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0220002","Smile for Health Family C40A50","97057NJ022",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0220002-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","8","97057","NJ","Individual","Yes","23-1661402","97057NJ0240002","Smile for Health Family C40A50","97057NJ024",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0240002-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","9","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0110001","Smile for Health Child C60A80","97057NJ011",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","12","85408","OK","Individual","No","26-3811422","85408OK0010008","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","12","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020008","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020008-01","Standard Gold On Exchange Plan","81.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","12","85408","OK","Individual","No","26-3811422","85408OK0010008","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010008-03","Limited Cost Sharing Plan Variation","81.80%","0.856459856033325","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020010","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020010-00","Standard Silver Off Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-01","Standard Silver On Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020010","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020010-01","Standard Silver On Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","5"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","4","53524","OK","Individual","No","75-1296086","53524OK0050004","Bronze Deductible Only PPO Exchange","53524OK005",,"OKN001","OKS001","OKF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72505","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","4","53524","OK","Individual","No","75-1296086","53524OK0050004","Bronze Deductible Only PPO Exchange","53524OK005",,"OKN001","OKS001","OKF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72505","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","4","53524","OK","Individual","No","75-1296086","53524OK0050004","Bronze Deductible Only PPO Exchange","53524OK005",,"OKN001","OKS001","OKF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72505","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","3","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0050001","Guardian Family Essentials Plus","81457OK005",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0050001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","4","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0040001","Guardian Family Advantage","81457OK004",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0040001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","4","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0040001","Guardian Family Advantage","81457OK004",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0040001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","Individual","Yes","23-1661402","97057NJ0010001","Smile for Health Child C60A70","97057NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0090001","Smile for Health Child C60A70","97057NJ009",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a70-ppo.pdf",,,,"97057NJ0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","1","97057","NJ","Individual","Yes","23-1661402","97057NJ0010001","Smile for Health Child C60A70","97057NJ001",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","2","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0190001","Smile for Health Child C60","97057NJ019",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,,,,"97057NJ0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","2","97057","NJ","Individual","Yes","23-1661402","97057NJ0170001","Smile for Health Child C60","97057NJ017",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0100001","Smile for Health Child C60A60","97057NJ010",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a60-ppo.pdf",,,,"97057NJ0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","Individual","Yes","23-1661402","97057NJ0020002","Smile for Health Family C60A60","97057NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0100002","Smile for Health Family C60A60","97057NJ010",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a60-ppo.pdf",,,,"97057NJ0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","Individual","Yes","23-1661402","97057NJ0020002","Smile for Health Family C60A60","97057NJ002",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","3","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0100002","Smile for Health Family C60A60","97057NJ010",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a60-ppo.pdf",,,,"97057NJ0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0120001","Smile for Health Child C60A50","97057NJ012",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a50-ppo.pdf",,,,"97057NJ0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","Individual","Yes","23-1661402","97057NJ0040001","Smile for Health Child C60A50","97057NJ004",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0120001","Smile for Health Child C60A50","97057NJ012",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c60a50-ppo.pdf",,,,"97057NJ0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","Individual","Yes","23-1661402","97057NJ0040002","Smile For Health Family C60A50","97057NJ004",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$44.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0120002","Smile For Family C60A50","97057NJ012",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a50-ppo.pdf",,,,"97057NJ0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","4","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0120002","Smile For Family C60A50","97057NJ012",,"NJN001","NJS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-family-c60a50-ppo.pdf",,,,"97057NJ0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","5","97057","NJ","Individual","Yes","23-1661402","97057NJ0180001","Smile for Health Child C80","97057NJ018",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$50.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","5","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0200001","Smile for Health Child C80","97057NJ020",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"97057NJ0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0150001","Smile for Health Child C80A80","97057NJ015",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-grp-child-c80a80-ppo.pdf",,,,"97057NJ0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","6","97057","NJ","Individual","Yes","23-1661402","97057NJ0070001","Smile for Health Child C80A80","97057NJ007",,"NJN001","NJS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$50.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-nj-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"97057NJ0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130010","Delta Dental PPO - Basic EPO Family Plan","99708NJ013",,"NJN001","NJS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.90",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130010-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130013","Delta Dental PPO -Enhanced EPO/PPO Family Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130013-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130014","Delta Dental PPO - Basic EPO/PPO Family Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.86",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130014-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140006","Delta Dental PPO - Enhanced PPO/PPO+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140006-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140005","Delta Dental PPO - Basic PPO/PPO+ Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140005-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140010","Delta Dental PPO plus Premier - Enhanced POS Family Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.13",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140010-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","7","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0210001","Smile for Health Child C40","97057NJ021",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0210001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","8","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0220001","Smile for Health Child C40A50","97057NJ022",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0220001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","8","97057","NJ","Individual","Yes","23-1661402","97057NJ0240001","Smile for Health Child C40A50","97057NJ024",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.70",,"Guaranteed Rate",,"0","0","0","0001-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-nj-idental",,,"97057NJ0240001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","9","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0110002","Smile for Health Family C60A80","97057NJ011",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","10","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0140001","Smile for Health Child C80A60","97057NJ014",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","10","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0140002","Smile for Health Family C80A60","97057NJ014",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","11","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0130001","Smile for Health Child C80A70","97057NJ013",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","11","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0130002","Smile for Health Family C80A70","97057NJ013",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","97057","HIOS","9","2014-01-21 08:29:49","12","97057","NJ","SHOP (Small Group)","Yes","23-1661402","97057NJ0160001","Smile for Health Child C80A50","97057NJ016",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes",,,,,"97057NJ0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130005","Delta Dental PPO-Basic Pediatric Rider","99708NJ013",,"NJN001","NJS001",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$35.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130005-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","Individual","Yes","22-1896118","99708NJ0120004","Delta Dental Individual-Enhanced EPO Pediatric Essential Health Benefit","99708NJ012",,"NJN001","NJS001",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$62.31",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalcoversme.com","https://auth.deltadentalcoversme.com/sp/startSSO.ping?PartnerIdpId=deltadentalcoversme:saml2","http://deltadentalcoversme.com",,"99708NJ0120004-01","Standard High On Exchange Plan","86.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130006","Delta Dental PPO- Enhanced Pediatric Rider","99708NJ013",,"NJN001","NJS001",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$40.38",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130006-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140001","Delta Dental PPO plus Premier - Basic Pediatric Rider","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$50.43",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140002","Delta Dental PPO plus Premier - Enhanced Pediatric Rider","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$57.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140002-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130007","Delta Dental PPO - Basic Pediatric EPO Rider","99708NJ013",,"NJN001","NJS001",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$43.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130007-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130008","Delta Dental PPO - Enhanced Pediatric EPO Rider","99708NJ013",,"NJN001","NJS001",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$48.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130008-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130011","Delta Dental PPO-Enhanced Pediatric POS Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$34.97",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130011-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130012","Delta Dental PPO-Basic Pediatric POS Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$31.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130012-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140004","Delta Dental PPO plus Premier - Enhanced Pediatric Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$53.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140004-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","1","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0140003","Delta Dental PPO plus Premier - Basic Pediatric Plan","99708NJ014",,"NJN002","NJS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$47.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0140003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130002","Delta Dental PPO -Basic Family Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130002-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","Individual","Yes","22-1896118","99708NJ0120003","Delta Dental Individual and Family- Basic Plan","99708NJ012",,"NJN001","NJS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.56",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalcoversme.com","https://auth.deltadentalcoversme.com/sp/startSSO.ping?PartnerIdpId=deltadentalcoversme:saml2","http://www.deltadentalcoversme.com",,"99708NJ0120003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","Individual","Yes","22-1896118","99708NJ0120006","Delta Dental Individual and Family - Enhanced Plan","99708NJ012",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$61.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalcoversme.com","https://auth.deltadentalcoversme.com/sp/startSSO.ping?PartnerIdpId=deltadentalcoversme:saml2","http://www.deltadentalcoversme.com",,"99708NJ0120006-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130004","Delta Dental PPO -Enhanced Family Plan","99708NJ013",,"NJN001","NJS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.79",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130004-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NJ","99708","HIOS","5","2013-09-05 07:36:38","2","99708","NJ","SHOP (Small Group)","Yes","22-1896118","99708NJ0130009","Delta Dental PPO - Enhanced EPO Family Plan","99708NJ013",,"NJN001","NJS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$50.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available throughout the United States","Yes","http://www.deltadentalnj.com/HCR/Plans.html","http://www.deltadentalnj.com/employers/keycontacts_employers.html","http://www.deltadentalnj.com/HCR/Plans.html",,"99708NJ0130009-00","Standard High Off Exchange Plan","86.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","1","40254","OK","Individual","Yes","95-6042390","40254OK0020001","BESTOne Child Dental Plus","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Child_Dental_Plus_Plan.pdf",,"40254OK0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010001","BEST Life Child Dental Plus","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Child_Dental_Plus_Plan.pdf",,"40254OK0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","1","40254","OK","Individual","Yes","95-6042390","40254OK0020001","BESTOne Child Dental Plus","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Child_Dental_Plus_Plan.pdf",,"40254OK0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","1","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010001","BEST Life Child Dental Plus","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Child_Dental_Plus_Plan.pdf",,"40254OK0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010002","BEST Life Child Dental","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Child_Dental_Plan.pdf",,"40254OK0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","2","40254","OK","Individual","Yes","95-6042390","40254OK0020002","BESTOne Child Dental","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Child_Dental_Plan.pdf",,"40254OK0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","2","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010002","BEST Life Child Dental","40254OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Child_Dental_Plan.pdf",,"40254OK0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","2","40254","OK","Individual","Yes","95-6042390","40254OK0020002","BESTOne Child Dental","40254OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.30",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Child_Dental_Plan.pdf",,"40254OK0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010003","BEST Dental Advantage - Gold","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Advantage_Plan_(Gold).pdf",,"40254OK0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","Individual","Yes","95-6042390","40254OK0020003","BESTOne Dental Advantage - Gold","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"40254OK0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","SHOP (Small Group)","Yes","95-6042390","40254OK0010003","BEST Dental Advantage - Gold","40254OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BEST_Dental_Advantage_Plan_(Gold).pdf",,"40254OK0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","40254","HIOS","7","2014-01-21 08:29:49","3","40254","OK","Individual","Yes","95-6042390","40254OK0020003","BESTOne Dental Advantage - Gold","40254OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OK/pdf/OK_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"40254OK0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","3","45689","OK","Individual","Yes","75-1233841","45689OK0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","45689OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010004",,"45689OK0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","3","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020004",,"45689OK0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","3","45689","OK","Individual","Yes","75-1233841","45689OK0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","45689OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ok/45689ok0010004",,"45689OK0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","45689","HIOS","5","2014-01-17 09:36:20","3","45689","OK","SHOP (Small Group)","Yes","75-1233841","45689OK0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","45689OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ok/45689ok0020004",,"45689OK0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","1","53524","OK","Individual","No","75-1296086","53524OK0050001","Gold $5 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72521","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","1","53524","OK","Individual","No","75-1296086","53524OK0050001","Gold $5 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72521","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","1","53524","OK","Individual","No","75-1296086","53524OK0050001","Gold $5 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72521","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-04","73% AV Level Silver Plan","73.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","6","76668","OK","Individual","No","48-0840330","76668OK0040002","Silver $10 Copay POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72500","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040002-06","94% AV Level Silver Plan","94.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","7","76668","OK","Individual","No","48-0840330","76668OK0040005","Catastrophic 100% POS Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF006","New","POS","Catastrophic","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72544","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","1","77760","OK","Individual","Yes","23-7322578","77760OK0010001","PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,"6 month wait on Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$40.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/High","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0010001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","1","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020001","PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,"6 month wait on Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$39.31",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/High",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0020001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","2","77760","OK","Individual","Yes","23-7322578","77760OK0010002","PPO Plus Premier - Federally Compliant Plan","77760OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,"6 month wait of Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Combined/Low","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0010002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","2","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020002","PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,"6 month wait of Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$32.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0020002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","3","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040001","PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0040001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","3","77760","OK","Individual","Yes","23-7322578","77760OK0030001","PPO Plus Premier - Federally Compliant Plan","77760OK003",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Pedo/High","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0030001-00","Standard High Off Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","3","77760","OK","Individual","Yes","23-7322578","77760OK0030001","PPO Plus Premier - Federally Compliant Plan","77760OK003",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.33",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Pedo/High","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0030001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","3","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040001","PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/High",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0040001-01","Standard High On Exchange Plan","85.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","4","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040002","PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0040002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","4","77760","OK","Individual","Yes","23-7322578","77760OK0030002","PPO Plus Premier - Federally Compliant Plan","77760OK003",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Pedo/Low","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0030002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","4","77760","OK","Individual","Yes","23-7322578","77760OK0030002","PPO Plus Premier - Federally Compliant Plan","77760OK003",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/Individual/Pedo/Low","https://auth.deltadentalcoversme.com/sp/ACS.saml2","www.deltadentalok.org/client/marketplace/Brochure/Individual",,"77760OK0030002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","4","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0040002","PPO Plus Premier - Federally Compliant Plan","77760OK004",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Pedo/Low",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0040002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0010001","Guardian Pediatric Advantage","81457OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0010001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0010001","Guardian Pediatric Advantage","81457OK001",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0010001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0020001","Guardian Pediatric Essentials","81457OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0020001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","1","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0020001","Guardian Pediatric Essentials","81457OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0020001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","2","53524","OK","Individual","No","75-1296086","53524OK0050002","Silver $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72527","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","3","53524","OK","Individual","No","75-1296086","53524OK0050003","Bronze $10 Copay PPO Exchange","53524OK005",,"OKN001","OKS001","OKF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72518","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","11","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020006","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020006-00","Standard Gold Off Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","11","85408","OK","Individual","No","26-3811422","85408OK0010006","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","11","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020006","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020006-01","Standard Gold On Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","11","85408","OK","Individual","No","26-3811422","85408OK0010006","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010006-03","Limited Cost Sharing Plan Variation","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","12","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020008","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020008-00","Standard Gold Off Exchange Plan","81.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","12","85408","OK","Individual","No","26-3811422","85408OK0010008","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010008-01","Standard Gold On Exchange Plan","81.80%","0.856459856033325","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","4"
"2014","OK","53524","HIOS","6","2013-11-26 13:14:08","4","53524","OK","Individual","No","75-1296086","53524OK0050005","Catastrophic 100% PPO Exchange","53524OK005",,"OKN001","OKS001","OKF006","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/OK72542","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppook","www.c1formularyhix.com","53524OK0050005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","1","66946","OK","Individual","No","06-6033492","66946OK0080001","Aetna Advantage 5750 PD","66946OK008",,"OKN001","OKS001","OKF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$17,250","$34,500","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","1","66946","OK","Individual","No","06-6033492","66946OK0080001","Aetna Advantage 5750 PD","66946OK008",,"OKN001","OKS001","OKF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$17,250","$34,500","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","1","66946","OK","Individual","No","06-6033492","66946OK0080001","Aetna Advantage 5750 PD","66946OK008",,"OKN001","OKS001","OKF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$17,250","$34,500","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","2","66946","OK","Individual","No","06-6033492","66946OK0080002","Aetna Advantage 6350","66946OK008",,"OKN001","OKS001","OKF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$22,500","$45,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","2","66946","OK","Individual","No","06-6033492","66946OK0080002","Aetna Advantage 6350","66946OK008",,"OKN001","OKS001","OKF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$22,500","$45,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","2","66946","OK","Individual","No","06-6033492","66946OK0080002","Aetna Advantage 6350","66946OK008",,"OKN001","OKS001","OKF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$22,500","$45,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","4","66946","OK","Individual","No","06-6033492","66946OK0080004","Aetna AdvantagePlus 5500 PD","66946OK008",,"OKN001","OKS001","OKF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","4","66946","OK","Individual","No","06-6033492","66946OK0080004","Aetna AdvantagePlus 5500 PD","66946OK008",,"OKN001","OKS001","OKF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","4","66946","OK","Individual","No","06-6033492","66946OK0080004","Aetna AdvantagePlus 5500 PD","66946OK008",,"OKN001","OKS001","OKF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","5","66946","OK","Individual","No","06-6033492","66946OK0080008","Aetna Classic 3500 PD","66946OK008",,"OKN001","OKS001","OKF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$19,050","$38,100","Not Applicable","Not Applicable","$0","$0","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","8","66946","OK","Individual","No","06-6033492","66946OK0080007","Aetna Premier 2000 PD","66946OK008",,"OKN001","OKS001","OKF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","8","66946","OK","Individual","No","06-6033492","66946OK0080007","Aetna Premier 2000 PD","66946OK008",,"OKN001","OKS001","OKF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$13,500","$27,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","8","66946","OK","Individual","No","06-6033492","66946OK0080007","Aetna Premier 2000 PD","66946OK008",,"OKN001","OKS001","OKF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","66946","HIOS","7","2013-09-17 16:07:07","9","66946","OK","Individual","No","06-6033492","66946OK0080005","Aetna Basic","66946OK008",,"OKN001","OKS001","OKF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997341277587529",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/ok.html","66946OK0080005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$22,500","$45,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","1","76668","OK","Individual","No","48-0840330","76668OK0030001","Gold $5 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72535","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","1","76668","OK","Individual","No","48-0840330","76668OK0030001","Gold $5 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72535","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","1","76668","OK","Individual","No","48-0840330","76668OK0030001","Gold $5 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72535","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-04","73% AV Level Silver Plan","73.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","2","76668","OK","Individual","No","48-0840330","76668OK0030002","Silver $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72540","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030002-06","94% AV Level Silver Plan","94.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0030003","Bronze $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72533","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0030003","Bronze $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72533","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0030003","Bronze $10 Copay HMO Integris","76668OK003",,"OKN002","OKS002","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72533","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0040003","Bronze $10 Copay HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72530","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0040003","Bronze $10 Copay HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72530","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","3","76668","OK","Individual","No","48-0840330","76668OK0040003","Bronze $10 Copay HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF005","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72530","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0030004","Bronze Deductible Only HSA Eligible HMO Integris","76668OK003",,"OKN002","OKS002","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72507","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0030004","Bronze Deductible Only HSA Eligible HMO Integris","76668OK003",,"OKN002","OKS002","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72507","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0030004","Bronze Deductible Only HSA Eligible HMO Integris","76668OK003",,"OKN002","OKS002","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72507","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0030005","Catastrophic 100% HMO Integris","76668OK003",,"OKN002","OKS002","OKF006","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72543","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmointegrisok","www.c1formularyhix.com","76668OK0030005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0040004","Bronze Deductible Only HSA Eligible HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72506","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OK","76668","HIOS","6","2013-11-26 13:14:08","4","76668","OK","Individual","No","48-0840330","76668OK0040004","Bronze Deductible Only HSA Eligible HMO Carelink - Tulsa Region","76668OK004",,"OKN001","OKS001","OKF006","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OK72506","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/postulsaok","www.c1formularyhix.com","76668OK0040004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","OK","77760","HIOS","7","2013-09-10 14:43:20","2","77760","OK","SHOP (Small Group)","Yes","23-7322578","77760OK0020002","PPO Plus Premier - Federally Compliant Plan","77760OK002",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,"6 month wait of Type B services and 12-month wait on Type C services-adult only",,,,,"Allows Adult and Child-Only",,,,"$32.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","all benefits that are offered on the plan","Yes","all benefits that are offered on the plan","Yes","www.deltadentalok.org/client/marketplace/SBC/SHOP/Combined/Low",,"www.deltadentalok.org/client/marketplace/Brochure/SHOP",,"77760OK0020002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","2","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0030001","Guardian Family Advantage Plus","81457OK003",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0030001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","2","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0030001","Guardian Family Advantage Plus","81457OK003",,"OKN001","OKS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0030001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","3","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0050001","Guardian Family Essentials Plus","81457OK005",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0050001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","4","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0060001","Guardian Family Essentials","81457OK006",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0060001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","81457","HIOS","4","2013-09-02 11:39:25","4","81457","OK","SHOP (Small Group)","Yes","13-5123390","81457OK0060001","Guardian Family Essentials","81457OK006",,"OKN001","OKS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"81457OK0060001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","1","85408","OK","Individual","No","26-3811422","85408OK0010001","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010001-01","Standard Platinum On Exchange Plan","89.50%","0.858872473239899","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","1","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020001","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020001-00","Standard Platinum Off Exchange Plan","89.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","1","85408","OK","Individual","No","26-3811422","85408OK0010001","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","1","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020001","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020001-01","Standard Platinum On Exchange Plan","89.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","1","85408","OK","Individual","No","26-3811422","85408OK0010001","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010001-03","Limited Cost Sharing Plan Variation","89.50%","0.886222958564758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","2","85408","OK","Individual","No","26-3811422","85408OK0010003","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261406",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010003-01","Standard Platinum On Exchange Plan","91.40%","0.87183278799057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","2","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020003","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020003-00","Standard Platinum Off Exchange Plan","91.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","2","85408","OK","Individual","No","26-3811422","85408OK0010003","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261406",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","2","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020003","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020003-01","Standard Platinum On Exchange Plan","91.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","2","85408","OK","Individual","No","26-3811422","85408OK0010003","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261406",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010003-03","Limited Cost Sharing Plan Variation","91.40%","0.87183278799057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","3","85408","OK","Individual","No","26-3811422","85408OK0010005","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010005-01","Standard Gold On Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","3","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020005","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalSmallGroupSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020005-00","Standard Gold Off Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","3","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020005","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalSmallGroupSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020005-01","Standard Gold On Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","3","85408","OK","Individual","No","26-3811422","85408OK0010005","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","3","85408","OK","Individual","No","26-3811422","85408OK0010005","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1plusDentalIndividualSB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010005-03","Limited Cost Sharing Plan Variation","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","80%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","4","85408","OK","Individual","No","26-3811422","85408OK0010007","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010007-01","Standard Gold On Exchange Plan","81.80%","0.83566802740097","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","4","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020007","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020007-00","Standard Gold Off Exchange Plan","81.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","4","85408","OK","Individual","No","26-3811422","85408OK0010007","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","4","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020007","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020007-01","Standard Gold On Exchange Plan","81.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","4","85408","OK","Individual","No","26-3811422","85408OK0010007","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010007-03","Limited Cost Sharing Plan Variation","81.80%","0.83566802740097","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$700","$200","$800","$20","$300","$30","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-01","Standard Silver On Exchange Plan","70.40%","0.685013175010681","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020009","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023358",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1plusDentalSmallGroupSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020009-00","Standard Silver Off Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020009","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023358",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1plusDentalSmallGroupSBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020009-01","Standard Silver On Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-03","Limited Cost Sharing Plan Variation","70.40%","0.685013175010681","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$70","$0","$200","$1,800","$1,200","$0","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-04","73% AV Level Silver Plan","72.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$80","$0","$200","$1,300","$1,300","$0","$80","7"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-05","87% AV Level Silver Plan","86.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$2,000","$50","$0","$200","$1,300","$1,100","$0","$80","8"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","5","85408","OK","Individual","No","26-3811422","85408OK0010009","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010009-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$500","$0","$200","$0","$500","$200","$80","9"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-01","Standard Silver On Exchange Plan","71.20%","0.757111966609955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020011","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020011-00","Standard Silver Off Exchange Plan","71.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020011","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020011-01","Standard Silver On Exchange Plan","71.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-03","Limited Cost Sharing Plan Variation","71.20%","0.757111966609955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-04","73% AV Level Silver Plan","73.60%","0.759533166885376","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$1,800","$0","$1,400","$200","$1,300","$300","$800","$70","7"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-05","87% AV Level Silver Plan","87.10%","0.881624817848206","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","35%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$800","$200","$800","$100","$600","$80","8"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","6","85408","OK","Individual","No","26-3811422","85408OK0010011","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010011-06","94% AV Level Silver Plan","93.40%","0.942855298519135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$800","$200","$0","$80","$700","$70","9"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","7","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020013","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023354",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Smal_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020013-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","7","85408","OK","Individual","No","26-3811422","85408OK0010013","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010013-01","Standard Bronze On Exchange Plan","61.30%","0.627963840961456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","7","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020013","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023354",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Smal_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020013-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","7","85408","OK","Individual","No","26-3811422","85408OK0010013","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","7","85408","OK","Individual","No","26-3811422","85408OK0010013","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010013-03","Limited Cost Sharing Plan Variation","61.30%","0.627963840961456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","8","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020015","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020015-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","8","85408","OK","Individual","No","26-3811422","85408OK0010015","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010015-01","Standard Bronze On Exchange Plan","61.90%","0.660963237285614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$150","$2,300","$200","$1,300","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","8","85408","OK","Individual","No","26-3811422","85408OK0010015","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","8","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020015","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020015-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","8","85408","OK","Individual","No","26-3811422","85408OK0010015","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Dental_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010015-03","Limited Cost Sharing Plan Variation","61.90%","0.660963237285614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$150","$2,300","$200","$1,300","$50","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","9","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020002","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No",,,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020002-00","Standard Platinum Off Exchange Plan","89.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","9","85408","OK","Individual","No","26-3811422","85408OK0010002","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010002-01","Standard Platinum On Exchange Plan","89.50%","0.858872473239899","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","9","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020002","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No",,,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020002-01","Standard Platinum On Exchange Plan","89.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","9","85408","OK","Individual","No","26-3811422","85408OK0010002","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","9","85408","OK","Individual","No","26-3811422","85408OK0010002","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF002","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010002-03","Limited Cost Sharing Plan Variation","89.50%","0.858872473239899","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$800","$0","$200","$0","$400","$200","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","10","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020004","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020004-00","Standard Platinum Off Exchange Plan","91.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","10","85408","OK","Individual","No","26-3811422","85408OK0010004","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010004-01","Standard Platinum On Exchange Plan","91.40%","0.87183278799057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","10","85408","OK","Individual","No","26-3811422","85408OK0010004","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","10","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020004","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Small_Group_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020004-01","Standard Platinum On Exchange Plan","91.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","10","85408","OK","Individual","No","26-3811422","85408OK0010004","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF003","New","HMO","Platinum","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261404",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Platinum2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010004-03","Limited Cost Sharing Plan Variation","91.40%","0.87183278799057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$600","$200","$0","$200","$400","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","11","85408","OK","Individual","No","26-3811422","85408OK0010006","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Gold1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010006-01","Standard Gold On Exchange Plan","81.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$10","$0","$200","$800","$200","$90","$30","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-04","73% AV Level Silver Plan","72.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$80","$0","$200","$1,300","$1,300","$0","$80","7"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-05","87% AV Level Silver Plan","86.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","$750","$1,500","$2,000","$50","$0","$200","$1,300","$1,100","$0","$80","8"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","13","85408","OK","Individual","No","26-3811422","85408OK0010010","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010010-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$500","$0","$200","$0","$500","$200","$80","9"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020012","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Smallgroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020012-00","Standard Silver Off Exchange Plan","71.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-01","Standard Silver On Exchange Plan","71.20%","0.757842779159546","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020012","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Smallgroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020012-01","Standard Silver On Exchange Plan","71.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-03","Limited Cost Sharing Plan Variation","71.20%","0.757842779159546","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$0","$1,300","$200","$1,700","$100","$0","$80","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-04","73% AV Level Silver Plan","73.60%","0.761695683002472","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","35%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$1,800","$0","$1,400","$200","$1,300","$300","$800","$70","7"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-05","87% AV Level Silver Plan","87.10%","0.880526065826416","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","35%",,,,"Not Applicable","Not Applicable","$750","$1,500","$800","$0","$800","$200","$800","$100","$600","$80","8"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","14","85408","OK","Individual","No","26-3811422","85408OK0010012","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF010","New","HMO","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261418",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Silver2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010012-06","94% AV Level Silver Plan","93.40%","0.950600445270538","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$800","$200","$0","$80","$700","$70","9"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","15","85408","OK","Individual","No","26-3811422","85408OK0010014","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010014-01","Standard Bronze On Exchange Plan","61.30%","0.642606377601624","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","15","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020014","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020014-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","15","85408","OK","Individual","No","26-3811422","85408OK0010014","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","15","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020014","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Small_Group_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020014-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","15","85408","OK","Individual","No","26-3811422","85408OK0010014","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF014","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze1_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010014-03","Limited Cost Sharing Plan Variation","61.30%","0.642606377601624","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$2,900","$0","$200","$2,000","$1,000","$200","$50","6"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","16","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020016","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020016-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","16","85408","OK","Individual","No","26-3811422","85408OK0010016","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010016-01","Standard Bronze On Exchange Plan","61.90%","0.660963237285614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","4"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","16","85408","OK","SHOP (Small Group)","No","26-3811422","85408OK0020016","GlobalHealth, Inc.","85408OK002",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","Both","No","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995673219023355",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_SmallGroup_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_SmallGroup_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0020016-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","16","85408","OK","Individual","No","26-3811422","85408OK0010016","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$50","5"
"2014","OK","85408","HIOS","4","2014-05-02 13:10:05","16","85408","OK","Individual","No","26-3811422","85408OK0010016","GlobalHealth, Inc.","85408OK001",,"OKN001","OKS001","OKF015","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease",,"0.995034161261408",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SBC.pdf","http://www.globalhealth.com","http://www.globalhealth.com/docs/member/ffm/Bronze2_Individual_SB.pdf","http://www.globalhealth.com/prescription_formulary.aspx","85408OK0010016-03","Limited Cost Sharing Plan Variation","61.90%","0.660963237285614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","$6,300","$12,600",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","50%",,,,"Not Applicable","Not Applicable","$2,250","$4,500","$2,300","$0","$3,100","$200","$2,300","$200","$1,300","$50","6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360003","Blue Advantage Silver PPO 003","87571OK036",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental 1A","87571OK039",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130008","3CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130008-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130008-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130008-03","Limited Cost Sharing Plan Variation",,"0.78142648935318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","9"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","7","98905","OK","Individual","No","73-1433979","98905OK0130010","2CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF005","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130010-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130010-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130010-01","Standard Bronze On Exchange Plan",,"0.603016912937164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$600","$0","$150","$1,300","$560","$0","$0","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300001","Blue Choice Gold PPO 001","87571OK030",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050010","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN001","PAS001","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998436837613718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050010-01","Standard Gold On Exchange Plan","79.10%","0.80987948179245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,300","$0","$500","$200","$1,300","$400","$100","$80","10"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050010","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN001","PAS001","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998436837613718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050010","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN001","PAS001","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998436837613718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050010-03","Limited Cost Sharing Plan Variation","79.10%","0.80987948179245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,300","$0","$500","$200","$1,300","$400","$100","$80","12"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-01","Standard Silver On Exchange Plan","71.20%","0.709953308105469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","10%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$1,800","$10","$600","$200","$1,800","$800","$400","$80","13"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-03","Limited Cost Sharing Plan Variation","71.20%","0.709953308105469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","10%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$1,800","$10","$600","$200","$1,800","$800","$400","$80","15"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-04","73% AV Level Silver Plan","73.90%","0.731859982013702","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$10","$600","$200","$1,500","$800","$500","$80","16"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400001","BlueCare Dental 1A","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290002","Blue Choice Gold PPO 002","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290002","Blue Choice Gold PPO 002","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030002","Select Plan","15614PA003",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0030002-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030002","Select Plan","15614PA003",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0030002-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0010002","Select Plan","15614PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0010002-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020002","Access PPO","15614PA002",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040002","Access PPO","15614PA004",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0040002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0020002","Access PPO","15614PA002",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0020002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040002","Access PPO","15614PA004",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0040002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070001","UPMC Dental Advantage Basic Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Basic_Serv29_Net11",,"16481PA0070001-01","Standard High On Exchange Plan","86.76%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-01","Standard Silver On Exchange Plan","71.20%","0.709953308105469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","10%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$1,800","$10","$600","$200","$1,800","$800","$400","$80","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO 004","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300004-00","Standard Silver Off Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040002","Small Business Advantage Premium Platinum 40","16481PA004",,"PAN004","PAS004","PAF011","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996047542703064",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium040_Platinum_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium040_Platinum_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040002-01","Standard Platinum  On Exchange Plan","91.10%","0.919140875339508","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$800","$0","$200","$0","$800","$0","$80","5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-03","Limited Cost Sharing Plan Variation","71.20%","0.709953308105469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","10%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$1,800","$10","$600","$200","$1,800","$800","$400","$80","6"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-04","73% AV Level Silver Plan","73.90%","0.731859982013702","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$10","$600","$200","$1,500","$800","$500","$80","7"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-05","87% AV Level Silver Plan","86.60%","0.875196635723114","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$400","$10","$700","$200","$400","$600","$600","$80","8"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050008","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998224072111291",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050008-06","94% AV Level Silver Plan","94.80%","0.942745923995972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$700","$200","$0","$200","$700","$80","9"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-05","87% AV Level Silver Plan","86.60%","0.875196635723114","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$400","$10","$700","$200","$400","$600","$600","$80","17"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400009","BlueCare Dental 1G","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400009-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","8","98905","OK","Individual","No","73-1433979","98905OK0130009","1CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130009-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130009-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130009-03","Limited Cost Sharing Plan Variation",,"0.602417349815369","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$0","$300","$150","$1,300","$630","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","9","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170023","5CCS-CommunityCare Silver Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170023-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170023-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170023-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","9","98905","OK","Individual","No","73-1433979","98905OK0130013","5CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130013-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130013-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130013-01","Standard Gold On Exchange Plan",,"0.781418263912201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","9","98905","OK","Individual","No","73-1433979","98905OK0130013","5CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130013-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130013-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","9","98905","OK","Individual","No","73-1433979","98905OK0130013","5CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130013-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130013-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130013-03","Limited Cost Sharing Plan Variation",,"0.781418263912201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170024","5CCG-CommunityCare Gold Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170024-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170024-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170024-01","Standard Gold On Exchange Plan",,"0.781418263912201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330001","Blue Preferred Gold PPO 001","87571OK033",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","8","98905","OK","Individual","No","73-1433979","98905OK0130009","1CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130009-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130009-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170021","2CCB-CommunityCare Bronze Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF005","New","HMO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170021-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170021-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170021-01","Standard Bronze On Exchange Plan",,"0.603016912937164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$600","$0","$150","$1,300","$560","$0","$0","5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320001","Blue Preferred Gold PPO 001","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320001","Blue Preferred Gold PPO 001","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170002","2CCS-CommunityCare Silver Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170002-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320001","Blue Preferred Gold PPO 001","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"46"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320001","Blue Preferred Gold PPO 001","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-03","Limited Cost Sharing Plan Variation",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-04","73% AV Level Silver Plan",,"0.735496997833252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","7"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-05","87% AV Level Silver Plan",,"0.870887637138367","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$700","$150","$500","$400","$160","$0","8"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-06","94% AV Level Silver Plan",,"0.93256801366806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$600","$0","$390","$150","$300","$300","$200","$0","9"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","3","98905","OK","Individual","No","73-1433979","98905OK0130003","1CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130003-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130003-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130003-01","Standard Platinum On Exchange Plan",,"0.919752240180969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$150","$0","$360","$260","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170004","1CCP ComunityCare Platinum Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170004-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170004-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170004-01","Standard Platinum On Exchange Plan",,"0.919752240180969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$150","$0","$360","$260","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","3","98905","OK","Individual","No","73-1433979","98905OK0130003","1CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130003-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130003-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","3","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170014","1CCP ComunityCare Platinum Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170014-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170014-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170014-01","Standard Platinum On Exchange Plan",,"0.919752240180969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$150","$0","$360","$260","$0","5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350002","Blue Advantage Gold PPO 002","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350002","Blue Advantage Gold PPO 002","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental 1B","87571OK039",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","Yes","36-1236610","87571OK0390002","BlueCare Dental 1B","87571OK039",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300005","Blue Choice Bronze PPO 005","87571OK030",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350005","Blue Advantage Bronze PPO 005","87571OK035",,"OKN003","OKS003","OKF008","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350001","Blue Advantage Gold PPO 001","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400001","BlueCare Dental 1A","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","Yes","36-1236610","87571OK0390001","BlueCare Dental 1A","87571OK039",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300001","Blue Choice Gold PPO 001","87571OK030",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350001","Blue Advantage Gold PPO 001","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350001","Blue Advantage Gold PPO 001","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400002","BlueCare Dental 1B","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO 002","87571OK030",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350002","Blue Advantage Gold PPO 002","87571OK035",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300002","Blue Choice Gold PPO 002","87571OK030",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400002","BlueCare Dental 1B","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400006","BlueCare Dental 1D","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400006-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO 003","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400006","BlueCare Dental 1D","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400006-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300003","Blue Choice Silver PPO 003","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300004","Blue Choice Silver PPO 004","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300004-01","Standard Silver On Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400009","BlueCare Dental 1G","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400009-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360001","Blue Advantage Gold PPO 001","87571OK036",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360002","Blue Advantage Gold PPO 002","87571OK036",,"OKN003","OKS003","OKF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350003","Blue Advantage Silver PPO 003","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360004","Blue Advantage Silver PPO 004","87571OK036",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360004-01","Standard Silver On Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330001","Blue Preferred Gold PPO 001","87571OK033",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO 002","87571OK033",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330002","Blue Preferred Gold PPO 002","87571OK033",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO 003","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330003","Blue Preferred Silver PPO 003","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0350004","Blue Advantage Silver PPO 004","87571OK035",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290001","Blue Choice Gold PPO 001","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO 004","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330004-00","Standard Silver Off Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290001","Blue Choice Gold PPO 001","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330004","Blue Preferred Silver PPO 004","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330004-01","Standard Silver On Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290001","Blue Choice Gold PPO 001","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290001","Blue Choice Gold PPO 001","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290002","Blue Choice Gold PPO 002","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290002","Blue Choice Gold PPO 002","87571OK029",,"OKN001","OKS001","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290003","Blue Choice Silver PPO 003","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","7","98905","OK","Individual","No","73-1433979","98905OK0130010","2CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF005","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130010-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130010-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","7","98905","OK","Individual","No","73-1433979","98905OK0130010","2CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF005","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130010-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130010-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130010-03","Limited Cost Sharing Plan Variation",,"0.603016912937164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$600","$0","$150","$1,300","$560","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","8","98905","OK","Individual","No","73-1433979","98905OK0130009","1CCB-CommunityCare Bronze Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130009-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130009-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130009-01","Standard Bronze On Exchange Plan",,"0.602417349815369","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$0","$300","$150","$1,300","$630","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","8","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170010","2CCB-CommunityCare Bronze Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF005","New","HMO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170010-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170010-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170010-01","Standard Bronze On Exchange Plan",,"0.603016912937164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$600","$0","$150","$1,300","$560","$0","$0","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0290004","Blue Choice Silver PPO 004","87571OK029",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","3","98905","OK","Individual","No","73-1433979","98905OK0130003","1CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130003-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130003-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130003-03","Limited Cost Sharing Plan Variation",,"0.919752240180969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$200","$0","$150","$0","$360","$260","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170006","3CCP ComunityCare Platinum Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170006-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170006-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170006-01","Standard Platinum On Exchange Plan",,"0.880890488624573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$350","$150","$500","$360","$160","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","4","98905","OK","Individual","No","73-1433979","98905OK0130005","3CCP ComunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130005-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130005-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130005-01","Standard Platinum On Exchange Plan",,"0.88089257478714","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$350","$150","$500","$360","$160","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","4","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170016","3CCP ComunityCare Platinum Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170016-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170016-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170016-01","Standard Platinum On Exchange Plan",,"0.880890488624573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$350","$150","$500","$360","$160","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","4","98905","OK","Individual","No","73-1433979","98905OK0130005","3CCP ComunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130005-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130005-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","4","98905","OK","Individual","No","73-1433979","98905OK0130005","3CCP ComunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130005-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130005-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130005-03","Limited Cost Sharing Plan Variation",,"0.88089257478714","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$350","$150","$500","$360","$160","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","5","98905","OK","Individual","No","73-1433979","98905OK0130006","1CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"10","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130006-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130006-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130006-01","Standard Gold On Exchange Plan",,"0.819844603538513","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$500","$0","$150","$750","$430","$110","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170003","1CCG-CommunityCare Gold Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"10","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170003-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170003-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170003-01","Standard Gold On Exchange Plan",,"0.819844603538513","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$500","$0","$150","$750","$430","$110","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","5","98905","OK","Individual","No","73-1433979","98905OK0130006","1CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"10","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130006-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130006-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","5","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170017","1CCG-CommunityCare Gold Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"10","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170017-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170017-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170017-01","Standard Gold On Exchange Plan",,"0.819844603538513","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$500","$0","$150","$750","$430","$110","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","5","98905","OK","Individual","No","73-1433979","98905OK0130006","1CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"10","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130006-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130006-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130006-03","Limited Cost Sharing Plan Variation",,"0.819844603538513","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$500","$0","$150","$750","$430","$110","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170007","2CCG-CommunityCare Gold Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170007-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170007-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170007-01","Standard Gold On Exchange Plan",,"0.795462548732758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$520","$150","$1,000","$460","$60","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130007","2CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130007-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130007-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130007-01","Standard Gold On Exchange Plan",,"0.795462548732758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$520","$150","$1,000","$460","$60","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170008","3CCG-CommunityCare Gold Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170008-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170008-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170008-01","Standard Gold On Exchange Plan",,"0.78142648935318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320002","Blue Preferred Gold PPO 002","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320002","Blue Preferred Gold PPO 002","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320002","Blue Preferred Gold PPO 002","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"50"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320002","Blue Preferred Gold PPO 002","87571OK032",,"OKN002","OKS002","OKF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"52"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"53"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360007","Blue Advantage Silver PPO 007","87571OK036",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360007-01","Standard Silver On Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400008","BlueCare Dental 1F","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400008-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400008","BlueCare Dental 1F","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400008-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300017","Blue Choice Silver PPO 017","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300017-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300017","Blue Choice Silver PPO 017","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300017-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-03","Limited Cost Sharing Plan Variation",,"0.713963866233826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$100","$0","$150","$1,300","$460","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-04","73% AV Level Silver Plan",,"0.734450101852417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$1,000","$0","$150","$1,300","$430","$0","$0","7"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-05","87% AV Level Silver Plan",,"0.867454886436462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$300","$0","$150","$500","$400","$160","$0","8"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-06","94% AV Level Silver Plan",,"0.936218023300171","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$600","$200","$0","$150","$300","$300","$200","$0","9"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170013","2CCS-CommunityCare Silver Standard","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170013-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170013-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170013-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","2","98905","OK","Individual","No","73-1433979","98905OK0130002","2CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130002-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"54"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320003","Blue Preferred Silver PPO 003","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"58"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"59"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"60"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"61"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"62"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","1","87571","OK","Individual","No","36-1236610","87571OK0320004","Blue Preferred Silver PPO 004","87571OK032",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"65"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids 1A","87571OK039",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400003","BlueCare Dental 4 Kids 1A","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300005","Blue Choice Bronze PPO 005","87571OK030",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350005","Blue Advantage Bronze PPO 005","87571OK035",,"OKN003","OKS003","OKF008","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400003","BlueCare Dental 4 Kids 1A","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","Yes","36-1236610","87571OK0390003","BlueCare Dental 4 Kids 1A","87571OK039",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350005","Blue Advantage Bronze PPO 005","87571OK035",,"OKN003","OKS003","OKF008","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350005-03","Limited Cost Sharing Plan Variation",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400004","BlueCare Dental 4 Kids 1B","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO 006","87571OK030",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids 1B","87571OK039",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300006","Blue Choice Bronze PPO 006","87571OK030",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","Yes","36-1236610","87571OK0390004","BlueCare Dental 4 Kids 1B","87571OK039",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsok.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsok.com/coverage/individual/on-exchange/dental/",,"87571OK0390004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400004","BlueCare Dental 4 Kids 1B","87571OK040",,"OKN004","OKS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.81",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO 006","87571OK035",,"OKN003","OKS003","OKF007","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO 006","87571OK035",,"OKN003","OKS003","OKF007","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360005","Blue Advantage Bronze PPO 005","87571OK036",,"OKN003","OKS003","OKF008","New","PPO","Bronze","No","On the Exchange","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0350006","Blue Advantage Bronze PPO 006","87571OK035",,"OKN003","OKS003","OKF007","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0350006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360006","Blue Advantage Bronze PPO 006","87571OK036",,"OKN003","OKS003","OKF007","New","PPO","Bronze","No","On the Exchange","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330005","Blue Preferred Bronze PPO 005","87571OK033",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330009","Blue Preferred Silver PPO 009","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330009-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330009","Blue Preferred Silver PPO 009","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330009-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","2","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070005","UPMC Dental Advantage Premium Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Premium_Serv29_Net11",,"16481PA0070005-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070002","UPMC Dental Advantage Basic Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Basic_Serv29_Net11",,"16481PA0070002-01","Standard Low On Exchange Plan","69.43%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040003","Small Business Advantage Premium Gold 1000","16481PA004",,"PAN004","PAS004","PAF013","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99561990975873",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium1000_Gold_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium1000_Gold_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040003-01","Standard Gold On Exchange Plan","82.00%","0.791689991950989","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$10","$600","$200","$1,000","$900","$40","$80","4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290005","Blue Choice Bronze PPO 005","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330005","Blue Preferred Bronze PPO 005","87571OK033",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290005","Blue Choice Bronze PPO 005","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO 006","87571OK033",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290005","Blue Choice Bronze PPO 005","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330006","Blue Preferred Bronze PPO 006","87571OK033",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290005","Blue Choice Bronze PPO 005","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290006","Blue Choice Bronze PPO 006","87571OK029",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290006","Blue Choice Bronze PPO 006","87571OK029",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290006","Blue Choice Bronze PPO 006","87571OK029",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"16"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290006","Blue Choice Bronze PPO 006","87571OK029",,"OKN001","OKS001","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290010","Blue Security Choice PPO 010","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0290010","Blue Security Choice PPO 010","87571OK029",,"OKN001","OKS001","OKF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0290010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320005","Blue Preferred Bronze PPO 005","87571OK032",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320005","Blue Preferred Bronze PPO 005","87571OK032",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320005","Blue Preferred Bronze PPO 005","87571OK032",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320005","Blue Preferred Bronze PPO 005","87571OK032",,"OKN002","OKS002","OKF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO 006","87571OK032",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO 006","87571OK032",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO 006","87571OK032",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","2","87571","OK","Individual","No","36-1236610","87571OK0320006","Blue Preferred Bronze PPO 006","87571OK032",,"OKN002","OKS002","OKF003","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0320006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO 016","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300016-00","Standard Silver Off Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400005","BlueCare Dental 1C","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400005-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400005","BlueCare Dental 1C","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$57.29",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400005-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0300016","Blue Choice Silver PPO 016","87571OK030",,"OKN001","OKS001","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0300016-01","Standard Silver On Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO 008","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330008-00","Standard Silver Off Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400007","BlueCare Dental 1E","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400007-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0330008","Blue Preferred Silver PPO 008","87571OK033",,"OKN002","OKS002","OKF002","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0330008-01","Standard Silver On Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","3","87571","OK","SHOP (Small Group)","Yes","36-1236610","87571OK0400007","BlueCare Dental 1E","87571OK040",,"OKN004","OKS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsok.com/employer/products/on-exchange/dental/",,"87571OK0400007-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","HIOS","9","2014-01-21 08:29:49","4","87571","OK","SHOP (Small Group)","No","36-1236610","87571OK0360008","Blue Advantage Silver PPO 008","87571OK036",,"OKN003","OKS003","OKF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/employer/products/on-exchange/",,"http://www.bcbsok.com/employer/products/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0360008-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87698","HIOS","7","2014-07-25 16:54:18","1","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090001","4CCS-CommunityCare Silver Marketplace Select","87698OK009","7912900140","OKN001","OKS001","OKF002","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","Yes","http://marketplace.ccok.com?plan=201487698OK0090001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201487698OK0090001-01","http://marketplace.ccok.com?rxFormulary=1","87698OK0090001-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","4"
"2014","OK","87698","HIOS","7","2014-07-25 16:54:18","2","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090002","4CCP-CommunityCare Platinum Marketplace Select","87698OK009","7912900140","OKN001","OKS001","OKF001","New","PPO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","Yes","http://marketplace.ccok.com?plan=201487698OK0090002-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201487698OK0090002-01","http://marketplace.ccok.com?rxFormulary=1","87698OK0090002-01","Standard Platinum On Exchange Plan",,"0.893551170825958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$400","$150","$250","$390","$105","$0","4"
"2014","OK","87698","HIOS","7","2014-07-25 16:54:18","3","87698","OK","SHOP (Small Group)","No","73-1580741","87698OK0090003","4CCG-CommunityCare Gold Marketplace Select","87698OK009","7912900140","OKN001","OKS001","OKF003","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","Yes","http://marketplace.ccok.com?plan=201487698OK0090003-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201487698OK0090003-01","http://marketplace.ccok.com?rxFormulary=1","87698OK0090003-01","Standard Gold On Exchange Plan",,"0.804708302021027","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$400","$0","$0","4"
"2014","OK","91848","HIOS","2","2013-08-30 07:44:10","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010001","DentalConnect�","91848OK001",,"OKN001","OKS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"91848OK0010001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","91848","HIOS","2","2013-08-30 07:44:10","1","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010002","DentalConnect�","91848OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"91848OK0010002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OK","91848","HIOS","2","2013-08-30 07:44:10","2","91848","OK","SHOP (Small Group)","Yes","35-0472300","91848OK0010003","DentalConnect�","91848OK001",,"OKN001","OKS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.04",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"91848OK0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170001","1CCS-CommunityCare Silver Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170001-01","Standard Silver On Exchange Plan",,"0.713963866233826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$100","$0","$150","$1,300","$460","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-01","Standard Silver On Exchange Plan",,"0.713963866233826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$100","$0","$150","$1,300","$460","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170012","1CCS-CommunityCare Silver Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170012-01","Standard Silver On Exchange Plan",,"0.713963866233826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$100","$0","$150","$1,300","$460","$0","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","1","98905","OK","Individual","No","73-1433979","98905OK0130001","1CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Emergency Services","No","http://marketplace.ccok.com?plan=201498905OK0130001-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130001-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130007","2CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130007-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130007-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170018","2CCG-CommunityCare Gold Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170018-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170018-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170018-01","Standard Gold On Exchange Plan",,"0.795462548732758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$520","$150","$1,000","$460","$60","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130007","2CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130007-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130007-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130007-03","Limited Cost Sharing Plan Variation",,"0.795462548732758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$520","$150","$1,000","$460","$60","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130008","3CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130008-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130008-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130008-01","Standard Gold On Exchange Plan",,"0.78142648935318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","7"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170019","3CCG-CommunityCare Gold Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170019-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170019-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170019-01","Standard Gold On Exchange Plan",,"0.78142648935318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$0","$420","$150","$1,300","$460","$0","$0","7"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","6","98905","OK","Individual","No","73-1433979","98905OK0130008","3CCG-CommunityCare Gold Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130008-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130008-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-01","Standard Silver On Exchange Plan",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-03","Limited Cost Sharing Plan Variation",,"0.707566738128662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$560","$0","$0","6"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-04","73% AV Level Silver Plan",,"0.735496997833252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$0","$480","$150","$1,300","$470","$0","$0","7"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-05","87% AV Level Silver Plan",,"0.870887637138367","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$700","$150","$500","$400","$160","$0","8"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","10","98905","OK","Individual","No","73-1433979","98905OK0130012","5CCS-CommunityCare Silver Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF003","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130012-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130012-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130012-06","94% AV Level Silver Plan",,"0.93256801366806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$600","$0","$390","$150","$300","$300","$200","$0","9"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","11","98905","OK","Individual","No","73-1433979","98905OK0130011","1CCF-CommunityCare Fundamental Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF006","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130011-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130011-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$0","$0","$150","$4,000","$135","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170005","2CCP ComunityCare Platinum Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170005-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170005-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170005-01","Standard Platinum On Exchange Plan",,"0.899658501148224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$200","$0","$150","$250","$390","$210","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","11","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170015","2CCP ComunityCare Platinum Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170015-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170015-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170015-01","Standard Platinum On Exchange Plan",,"0.899658501148224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$200","$0","$150","$250","$390","$210","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","12","98905","OK","Individual","No","73-1433979","98905OK0130004","2CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130004-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130004-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130004-01","Standard Platinum On Exchange Plan",,"0.899658501148224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$200","$0","$150","$250","$390","$210","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170009","1CCB-CommunityCare Bronze Marketplace Select","98905OK017","7003819233","OKN001","OKS001","OKF004","New","HMO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170009-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170009-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170009-01","Standard Bronze On Exchange Plan",,"0.602417349815369","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$0","$300","$150","$1,300","$630","$0","$0","4"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","12","98905","OK","Individual","No","73-1433979","98905OK0130004","2CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130004-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130004-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","12","98905","OK","SHOP (Small Group)","No","73-1433979","98905OK0170020","1CCB-CommunityCare Bronze Marketplace Standard","98905OK017","7003819233","OKN002","OKS002","OKF004","New","HMO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0170020-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0170020-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0170020-01","Standard Bronze On Exchange Plan",,"0.602417349815369","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$0","$300","$150","$1,300","$630","$0","$0","5"
"2014","OK","98905","HIOS","7","2014-07-25 16:54:18","12","98905","OK","Individual","No","73-1433979","98905OK0130004","2CCP CommunityCare Platinum Marketplace Select","98905OK013","7003819233","OKN001","OKS001","OKF001","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pain Management",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Emergency Services Only","No","http://marketplace.ccok.com?plan=201498905OK0130004-01&type=sbc","https://www.ccok.softheon.com/payment","http://marketplace.ccok.com?plan=201498905OK0130004-01","http://marketplace.ccok.com?rxFormulary=1","98905OK0130004-03","Limited Cost Sharing Plan Variation",,"0.899658501148224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$200","$0","$150","$250","$390","$210","$0","6"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010001","Select Plan Kids","15614PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0010001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030001","Select Plan Kids","15614PA003",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0030001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0030001","Select Plan Kids","15614PA003",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0030001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0010001","Select Plan Kids","15614PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0010001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020001","Access PPO Kids","15614PA002",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040001","Access PPO Kids","15614PA004",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0040001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","Individual","Yes","54-1808292","15614PA0020001","Access PPO Kids","15614PA002",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","1","15614","PA","SHOP (Small Group)","Yes","54-1808292","15614PA0040001","Access PPO Kids","15614PA004",,"PAN002","PAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/pa14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0040001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","15614","HIOS","4","2013-09-11 07:49:18","2","15614","PA","Individual","Yes","54-1808292","15614PA0010002","Select Plan","15614PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/pa14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-pennsylvania",,"15614PA0010002-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040001","Small Business Advantage Premium Platinum 25","16481PA004",,"PAN004","PAS004","PAF011","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996068631918169",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium025_Platinum_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium025_Platinum_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040001-01","Standard Platinum  On Exchange Plan","91.60%","0.92458313703537","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$400","$0","$200","$0","$900","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050015","UPMC Advantage Premium Savings Silver","16481PA005",,"PAN002","PAS002","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998234686559747",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050015-06","94% AV Level Silver Plan","94.80%","0.942745923995972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$700","$200","$0","$200","$700","$80","18"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050016","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998445066973723",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050016-01","Standard Gold On Exchange Plan","79.10%","0.80987948179245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,300","$0","$500","$200","$1,300","$400","$100","$80","19"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050016","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998445066973723",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","1","16481","PA","Individual","No","72-1527566","16481PA0050016","UPMC Advantage Premium Savings Gold","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998445066973723",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050016-03","Limited Cost Sharing Plan Variation","79.10%","0.80987948179245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,300","$0","$500","$200","$1,300","$400","$100","$80","21"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","2","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070003","UPMC Dental Advantage Standard Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Standard_Serv29_Net11",,"16481PA0070003-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","2","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060004","Small Business Advantage Enhanced Silver 1500","16481PA006",,"PAN005","PAS004","PAF018","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997816975964587",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced1500_Silver_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced1500_Silver_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060004-01","Standard Silver On Exchange Plan","69.40%","0.709099531173706","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,200","$200","$1,500","$1,000","$100","$80","4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-05","87% AV Level Silver Plan","88.00%","0.871870338916779","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-06","94% AV Level Silver Plan","94.72%","0.944604456424713","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040018"," Marketplace Solutions 13","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040018"," Marketplace Solutions 13","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040018-03","Limited Cost Sharing Plan Variation","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040020"," Marketplace HRA1","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$2,000.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040020-01","Standard Silver On Exchange Plan","70.27%","0.819352030754089","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040021"," Marketplace HRA2","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$2,500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040021-01","Standard Silver On Exchange Plan","70.55%","0.810913026332855","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050006","UPMC Advantage Premium Gold","16481PA005",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998399665769718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050006","UPMC Advantage Premium Gold","16481PA005",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998399665769718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050006-03","Limited Cost Sharing Plan Variation","79.10%","0.758425414562225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","12"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050012","UPMC Advantage Premium Gold","16481PA005",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998408290090309",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050012-01","Standard Gold On Exchange Plan","79.10%","0.758425414562225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","13"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-01","Standard Silver On Exchange Plan","71.60%","0.652644634246826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-03","Limited Cost Sharing Plan Variation","71.60%","0.652644634246826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","6"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-04","73% AV Level Silver Plan","73.90%","0.684160470962524","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,250","$4,500","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,300","$400","$400","$200","$1,300","$1,100","$0","$80","7"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-05","87% AV Level Silver Plan","86.60%","0.848126649856567","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$300","$600","$200","$500","$700","$400","$80","8"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050002","UPMC Advantage Premium Silver","16481PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998233883947068",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050002-06","94% AV Level Silver Plan","94.80%","0.947044432163239","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$50","$100","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$500","$200","$50","$300","$400","$80","9"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050006","UPMC Advantage Premium Gold","16481PA005",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998399665769718",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050006-01","Standard Gold On Exchange Plan","79.10%","0.758425414562225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","10"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050012","UPMC Advantage Premium Gold","16481PA005",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998408290090309",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050012","UPMC Advantage Premium Gold","16481PA005",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998408290090309",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Gold_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050012-03","Limited Cost Sharing Plan Variation","79.10%","0.758425414562225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","15"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-01","Standard Silver On Exchange Plan","71.60%","0.652644634246826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","16"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-03","Limited Cost Sharing Plan Variation","71.60%","0.652644634246826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","18"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-04","73% AV Level Silver Plan","73.90%","0.684160470962524","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,250","$4,500","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,300","$400","$400","$200","$1,300","$1,100","$0","$80","19"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-05","87% AV Level Silver Plan","86.60%","0.848126649856567","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$300","$600","$200","$500","$700","$400","$80","20"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","3","16481","PA","Individual","No","72-1527566","16481PA0050013","UPMC Advantage Premium Silver","16481PA005",,"PAN002","PAS002","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998244381778506",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Silver_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050013-06","94% AV Level Silver Plan","94.80%","0.947044432163239","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$50","$100","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$500","$200","$50","$300","$400","$80","21"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040004","Small Business Advantage Premium Platinum 250","16481PA004",,"PAN004","PAS004","PAF010","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996004678132499",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium250_Platinum_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_Premium250_Platinum_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040004-01","Standard Platinum  On Exchange Plan","90.10%","0.912496387958527","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$400","$0","$200","$0","$1,000","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070004","UPMC Dental Advantage Standard Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Standard_Serv29_Net11",,"16481PA0070004-01","Standard Low On Exchange Plan","69.43%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050001","UPMC Advantage Premium Bronze","16481PA005",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997865325235462",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050001-01","Standard Bronze On Exchange Plan","59.20%","0.736924946308136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","SHOP (Small Group)","Yes","72-1527566","16481PA0070006","UPMC Dental Advantage Premium Plan","16481PA007",,"PAN006","PAS004",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is through contracted wrap network.","No",,"https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_DAP_DentalAdvantage_Premium_Serv29_Net11",,"16481PA0070006-01","Standard Low On Exchange Plan","69.43%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$100","$300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050001","UPMC Advantage Premium Bronze","16481PA005",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997865325235462",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050001","UPMC Advantage Premium Bronze","16481PA005",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997865325235462",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv5_Net6","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050001-03","Limited Cost Sharing Plan Variation","59.20%","0.736924946308136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","6"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050011","UPMC Advantage Premium Bronze","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997880642675135",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050011-01","Standard Bronze On Exchange Plan","59.20%","0.736924946308136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","7"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050011","UPMC Advantage Premium Bronze","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997880642675135",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","4","16481","PA","Individual","No","72-1527566","16481PA0050011","UPMC Advantage Premium Bronze","16481PA005",,"PAN002","PAS002","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997880642675135",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_PPO_Premium_Bronze_Serv24_Net7","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0050011-03","Limited Cost Sharing Plan Variation","59.20%","0.736924946308136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","9"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","5","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040007","Inside Advantage for Small Business Platinum 500","16481PA004",,"PAN003","PAS003","PAF009","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995960873632106",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Platinum_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Platinum_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040007-01","Standard Platinum On Exchange Plan","89.10%",,"No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","0%","$1,000","$2,000","20%","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$400","$0","$200","$300","$300","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","6","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040009","Inside Advantage for Small Business Silver 5000","16481PA004",,"PAN003","PAS003","PAF015","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997864826029472",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Silver_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Silver_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040009-01","Standard Silver On Exchange Plan","68.80%","0.720889747142792","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","0%","$6,350","$12,700","20%","$6,350","$12,700","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$400","$0","$200","$1,300","$1,000","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","7","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060001","Small Business Advantage Enhanced Gold 2000","16481PA006",,"PAN005","PAS004","PAF015","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995452293277172",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced2000_Silver_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced2000_Silver_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060001-01","Standard Gold On Exchange Plan","78.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$400","$900","$200","$1,300","$1,000","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","8","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060002","Small Business Advantage Enhanced Bronze 4500","16481PA006",,"PAN005","PAS004","PAF020","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99748191549943",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced4500_Bronze_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced4500_Bronze_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060002-01","Standard Bronze On Exchange Plan","59.90%","0.645088911056519","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$10","$600","$200","$2,100","$700","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","8","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060003","Small Business Advantage Enhanced Bronze 3500","16481PA006",,"PAN005","PAS004","PAF019","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99753761170867",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced3500_Bronze_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced3500_Bronze_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060003-01","Standard Bronze On Exchange Plan","61.30%","0.655363142490387","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$10","$1,100","$200","$2,100","$700","$0","$80","5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040008"," Marketplace Solutions 5","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040008"," Marketplace Solutions 5","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040008-03","Limited Cost Sharing Plan Variation","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040023","Marketplace Extra 1","22444PA004",,"PAN001","PAS002","PAF007","New","POS","Platinum","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040023-01","Standard Platinum On Exchange Plan","88.01%","0.880499064922333","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040031","Marketplace Solutions 1","22444PA004",,"PAN001","PAS001","PAF009","New","POS","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040031-01","Standard Platinum On Exchange Plan","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040023","Marketplace Extra 1","22444PA004",,"PAN001","PAS002","PAF007","New","POS","Platinum","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040035"," Marketplace Solutions 4","22444PA004",,"PAN001","PAS001","PAF006","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040035-01","Standard Gold On Exchange Plan","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$125","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150006","Personal Choice PPO Platinum Premier HSA 50","31609PA015",,"PAN001","PAS001","PAF014","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","Yes","$750.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150006-01","Standard Platinum On Exchange Plan","88.39%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040007","Marketplace Solutions 4","22444PA004",,"PAN001","PAS001","PAF006","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040007","Marketplace Solutions 4","22444PA004",,"PAN001","PAS001","PAF006","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040007-03","Limited Cost Sharing Plan Variation","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$250","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","9","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060005","HealthyU for Small Business","16481PA006",,"PAN005","PAS004","PAF017","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"Yes","Yes","$120.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997882233408043",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_HealthyU_Silver_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_HealthyU_Silver_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060005-01","Standard Silver On Exchange Plan","71.70%","0.69719386100769","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$10","$1,300","$200","$2,000","$700","$30","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","10","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0060007","Small Business Advantage Enhanced Bronze 5500","16481PA006",,"PAN005","PAS004","PAF015","New","EPO","Bronze","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997406492986833",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced6400_Bronze_Serv29_Net10","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_EPO_Enhanced6400_Bronze_Serv29_Net10","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0060007-01","Standard Bronze On Exchange Plan","58.10%","0.573717951774597","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,500","$10","$0","$200","$2,600","$700","$0","$80","4"
"2014","PA","16481","HIOS","11","2014-03-19 07:06:49","11","16481","PA","SHOP (Small Group)","No","72-1527566","16481PA0040008","Inside Advantage for Small Business Gold 1250","16481PA004",,"PAN003","PAS003","PAF012","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995561865980466",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Medical and Dental Services","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Gold_Serv29_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_PPO_InsideAdvantage_Gold_Serv29_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","16481PA0040008-01","Standard Gold On Exchange Plan","80.90%",,"No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","Not Applicable","Not Applicable","$1,250","$2,500","0%","$2,500","$5,000","20%","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$400","$0","$200","$700","$600","$0","$80","4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040036"," Marketplace Solutions 5","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040036-01","Standard Gold On Exchange Plan","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040008"," Marketplace Solutions 5","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040008-01","Standard Gold On Exchange Plan","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-01","Standard Silver On Exchange Plan","71.55%","0.718790590763092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-03","Limited Cost Sharing Plan Variation","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-04","73% AV Level Silver Plan","72.75%","0.755517482757568","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","10","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150010","Personal Choice PPO Silver Premier HSA 25","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150010-01","Standard Silver On Exchange Plan","70.89%","0.708899855613709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","11","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150011","Personal Choice PPO Silver HSA","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150011-01","Standard Silver On Exchange Plan","70.04%","0.700439751148224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","9","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040049"," Marketplace Extra 2","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Gold","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040049-01","Standard Gold On Exchange Plan","79.25%","0.784791350364685","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,000","$24,000","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","$4,000","$8,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","9","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040027","Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","www.thehealthplan.com","www.thehealthplan.com","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040027-01","Standard Silver On Exchange Plan","71.39%","0.723810791969299","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000","Not Applicable","Not Applicable","$2,000","$4,000","30%","$2,000","$4,000","30%","$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","1","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150001","Personal Choice PPO Platinum Premier","31609PA015",,"PAN001","PAS001","PAF009","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150001-01","Standard Platinum On Exchange Plan","90.92%",,"No","No","No","100%",,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","1","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF001","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070001-01","Standard Platinum On Exchange Plan","88.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-01","Standard Silver On Exchange Plan","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040046"," Marketplace Solutions 13","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040046-01","Standard Bronze On Exchange Plan","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-03","Limited Cost Sharing Plan Variation","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-04","73% AV Level Silver Plan","72.37%","0.766054570674896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","15%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-05","87% AV Level Silver Plan","87.46%","0.889027893543243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040024","Marketplace Extra 2","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Gold","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040024-03","Limited Cost Sharing Plan Variation","79.25%","0.784791350364685","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,000","$24,000","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","$4,000","$8,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040030"," Marketplace Solutions 2","22444PA004",,"PAN001","PAS001","PAF008","New","POS","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040030-01","Standard Platinum On Exchange Plan","90.88%","0.910953402519226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040033"," Marketplace Solutions 3","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040033-01","Standard Gold On Exchange Plan","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","1","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF001","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","1","31609","PA","Individual","No","23-2184623","31609PA0070001","Personal Choice PPO Platinum","31609PA007",,"PAN001","PAS001","PAF001","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070001-03","Limited Cost Sharing Plan Variation","88.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-01","Standard Silver On Exchange Plan","71.39%","0.723810791969299","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000","Not Applicable","Not Applicable","$2,000","$4,000","30%","$2,000","$4,000","30%","$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040017"," Marketplace Solutions 12","22444PA004",,"PAN001","PAS001","PAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040017-01","Standard Bronze On Exchange Plan","60.45%","0.644440948963165","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$1,500","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040017"," Marketplace Solutions 12","22444PA004",,"PAN001","PAS001","PAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040005"," Marketplace Solutions 1","22444PA004",,"PAN001","PAS001","PAF009","New","POS","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040022"," Marketplace HRA3","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$1,500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040022-01","Standard Silver On Exchange Plan","70.65%","0.794281125068665","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040017"," Marketplace Solutions 12","22444PA004",,"PAN001","PAS001","PAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040017-03","Limited Cost Sharing Plan Variation","60.45%","0.644440948963165","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$1,500","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040005"," Marketplace Solutions 1","22444PA004",,"PAN001","PAS001","PAF009","New","POS","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040005-01","Standard Platinum On Exchange Plan","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040042"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040042-01","Standard Silver On Exchange Plan","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-03","Limited Cost Sharing Plan Variation","71.39%","0.723810791969299","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$15,000","$30,000","Not Applicable","Not Applicable","$2,000","$4,000","30%","$2,000","$4,000","30%","$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0110001","Guardian Family Advantage Plus","32561PA011",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available out of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0110001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","3","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0130001","Guardian Family Essentials Plus","32561PA013",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0130001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","3","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0130001","Guardian Family Essentials Plus","32561PA013",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0130001-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","4","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0120001","Guardian Family Advantage","32561PA012",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0120001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","4","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0120001","Guardian Family Advantage","32561PA012",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0120001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","4","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0140001","Guardian Family Essentials","32561PA014",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0140001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","4","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0140001","Guardian Family Essentials","32561PA014",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0140001-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","Individual","No","23-1294723","33709PA0420011","Flex Blue PPO 1000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998144828284007",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420011-01","Standard Gold On Exchange Plan","78.30%","0.782900393009186","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","3","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150003","Personal Choice PPO Gold Premier","31609PA015",,"PAN001","PAS001","PAF011","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150003-01","Standard Gold On Exchange Plan","81.73%",,"No","No","No","100%",,"$4,500","$9,000",,,"$18,000","$36,000","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","100%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","3","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF007","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronzereserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070006-01","Standard Bronze On Exchange Plan","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","3","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF007","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronzereserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","3","31609","PA","Individual","No","23-2184623","31609PA0070006","Personal Choice PPO Bronze Reserve","31609PA007",,"PAN001","PAS001","PAF007","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronzereserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070006-03","Limited Cost Sharing Plan Variation","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-04","73% AV Level Silver Plan","74.00%","0.74261862039566","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$15,000","$30,000","Not Applicable","Not Applicable","$2,000","$4,000","30%","$2,000","$4,000","30%","$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-05","87% AV Level Silver Plan","88.00%","0.875269174575806","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%","$175","$350","0%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040026"," Marketplace Extra 3","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Silver","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040026-06","94% AV Level Silver Plan","94.80%","0.946599423885345","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%","$100","$200","0%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","9","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040048"," Marketplace Extra 1","22444PA004",,"PAN001","PAS002","PAF007","New","POS","Platinum","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040048-01","Standard Platinum On Exchange Plan","88.10%","0.880499064922333","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","20","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150020","Personal Choice PPO Bronze Premier HRA","31609PA015",,"PAN001","PAS001","PAF016","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150020-01","Standard Bronze On Exchange Plan","61.89%","0.618927001953125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","21","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150021","Personal Choice PPO Bronze HRA","31609PA015",,"PAN001","PAS001","PAF017","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150021-01","Standard Bronze On Exchange Plan","60.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","Individual","Yes","13-5123390","32561PA0150001","Guardian Pediatric Advantage","32561PA015",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$37.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes",,,,,"32561PA0150001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0090001","Guardian Pediatric Advantage","32561PA009",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0090001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","Individual","Yes","13-5123390","32561PA0160001","Guardian Pediatric Essentials","32561PA016",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes",,,,,"32561PA0160001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040044"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040044-01","Standard Silver On Exchange Plan","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040043"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040043-01","Standard Silver On Exchange Plan","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040045"," Marketplace Solutions 12","22444PA004",,"PAN001","PAS001","PAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040045-01","Standard Bronze On Exchange Plan","60.45%","0.643306612968445","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040016"," Marketplace Solutions 11","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040016-06","94% AV Level Silver Plan","94.94%","0.936664581298828","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-01","Standard Silver On Exchange Plan","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-05","87% AV Level Silver Plan","87.46%","0.874518513679504","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040015"," Marketplace Solutions 10","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040015-06","94% AV Level Silver Plan","94.94%","0.93335235118866","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040019"," Marketplace Value","22444PA004",,"PAN001","PAS001","PAF001","New","POS","Catastrophic","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceValue.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","1","22444","PA","Individual","No","23-2311553","22444PA0040018"," Marketplace Solutions 13","22444PA004",,"PAN001","PAS001","PAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040018-01","Standard Bronze On Exchange Plan","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040005"," Marketplace Solutions 1","22444PA004",,"PAN001","PAS001","PAF009","New","POS","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040005-03","Limited Cost Sharing Plan Variation","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040007","Marketplace Solutions 4","22444PA004",,"PAN001","PAS001","PAF006","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040007-01","Standard Gold On Exchange Plan","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$250","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-03","Limited Cost Sharing Plan Variation","71.55%","0.718790590763092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040010"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040010-04","73% AV Level Silver Plan","73.76%","0.743696928024292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-01","Standard Silver On Exchange Plan","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-03","Limited Cost Sharing Plan Variation","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-04","73% AV Level Silver Plan","73.75%","0.746763467788696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420003","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997431379165988",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420003-03","Limited Cost Sharing Plan Variation","62.00%","0.619918048381805","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%","$4,000","$8,000","60%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390001","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997210992593791",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390001-01","Standard Bronze On Exchange Plan","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390001","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997210992593791",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390001","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997210992593791",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390001-03","Limited Cost Sharing Plan Variation","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390003","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997404673663666",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390003-01","Standard Bronze On Exchange Plan","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390003","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997404673663666",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","9","33709","PA","Individual","No","23-1294723","33709PA0390003","Shared Cost Blue PPO 5500 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997404673663666",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390003-03","Limited Cost Sharing Plan Variation","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-01","Standard Silver On Exchange Plan","71.60%","0.716458022594452","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%","$1,700","$3,400","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-01","Standard Silver On Exchange Plan","71.81%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$3,000","$6,000","5%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100006","Keystone HMO Silver","33871PA010",,"PAN001","PAS001","PAF011","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,"$125","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100006-01","Standard Silver On Exchange Plan","70.65%","0.706500768661499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-03","Limited Cost Sharing Plan Variation","71.81%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$3,000","$6,000","5%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-05","87% AV Level Silver Plan","88.00%","0.871913731098175","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040013"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040013-06","94% AV Level Silver Plan","94.72%","0.944616556167603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040002"," Marketplace Solutions 3","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040002-01","Standard Gold On Exchange Plan","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040002"," Marketplace Solutions 3","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040002"," Marketplace Solutions 3","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040002-03","Limited Cost Sharing Plan Variation","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-01","Standard Silver On Exchange Plan","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"26"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-03","Limited Cost Sharing Plan Variation","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-04","73% AV Level Silver Plan","73.75%","0.746763467788696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-05","87% AV Level Silver Plan","88.00%","0.871913731098175","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","7","22444","PA","Individual","No","23-2311553","22444PA0040014"," Marketplace Solutions 9","22444PA004",,"PAN001","PAS001","PAF004","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040014-06","94% AV Level Silver Plan","94.72%","0.944616556167603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040023","Marketplace Extra 1","22444PA004",,"PAN001","PAS002","PAF007","New","POS","Platinum","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040023-03","Limited Cost Sharing Plan Variation","88.01%","0.880499064922333","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040038"," Marketplace Solutions 6","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040038-01","Standard Silver On Exchange Plan","71.55%","0.721780359745026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040024","Marketplace Extra 2","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Gold","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040024-01","Standard Gold On Exchange Plan","79.25%","0.784791350364685","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,000","$24,000","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","$4,000","$8,000","Not Applicable","Not Applicable","$250","$500","0%","$250","$500","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040039","Marketplace Solutions 7","22444PA004",,"PAN001","PAS001","PAF007","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions7.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040039-01","Standard Silver On Exchange Plan","71.42%","0.721022725105286","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","Individual","No","23-2311553","22444PA0040024","Marketplace Extra 2","22444PA004",,"PAN001","PAS002","PAF003","New","POS","Gold","Yes","On the Exchange","No","Yes","Back Pain Management Program Services; Foot Care Services; Genetic Counseling and Testing; Organ, Bone Marrow, Stem Cell or Corneal Transplants, Evaluation and Related Services; and Scheduled Transportation Services","Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceExtra2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","22444","HIOS","9","2014-01-21 08:29:49","8","22444","PA","SHOP (Small Group)","No","23-2311553","22444PA0040041"," Marketplace Solutions 8","22444PA004",,"PAN001","PAS001","PAF003","New","POS","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/GHPMarketplaceSolutions8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","22444PA0040041-01","Standard Silver On Exchange Plan","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040002-03","Limited Cost Sharing Plan Variation","82.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100003","Keystone HMO Gold Premier","33871PA010",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","Yes","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100003-01","Standard Gold On Exchange Plan","81.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-03","Limited Cost Sharing Plan Variation","71.60%","0.716458022594452","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%","$1,700","$3,400","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-04","73% AV Level Silver Plan","74.00%","0.739640057086945","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","20%","$1,375","$2,750","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-05","87% AV Level Silver Plan","87.80%","0.877573370933533","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$500","$1,000","20%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-06","94% AV Level Silver Plan","94.00%","0.940462708473206","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%","$100","$200","20%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","11","33709","PA","Individual","No","23-1294723","33709PA0380001","Major Events Blue PPO 6350 a Community Blue plan","33709PA038",,"PAN001","PAS001","PAF002","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.996794008643353",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0380001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","Individual","Yes","75-1233841","46518PA0010002","Dentegra Dental PPO Children's Plan 85","46518PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.90",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010002",,"46518PA0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020002",,"46518PA0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","2","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020006",,"46518PA0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","2","46518","PA","Individual","Yes","75-1233841","46518PA0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","46518PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010006",,"46518PA0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","2","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020006",,"46518PA0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","2","46518","PA","Individual","Yes","75-1233841","46518PA0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","46518PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010006",,"46518PA0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","3","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020004",,"46518PA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","3","46518","PA","Individual","Yes","75-1233841","46518PA0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","46518PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.90",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010004",,"46518PA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","3","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020004",,"46518PA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","3","46518","PA","Individual","Yes","75-1233841","46518PA0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","46518PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.90",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010004",,"46518PA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","1","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0150001","Smile for Health Child C80A80","49275PA015",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c80a80-ppo.pdf",,,,"49275PA0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","1","49275","PA","Individual","Yes","23-1661402","49275PA0170001","Smile for Health Child C60","49275PA017",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-pa-idental",,,"49275PA0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-04","73% AV Level Silver Plan","72.50%","0.725402534008026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-05","87% AV Level Silver Plan","86.20%","0.86148464679718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-06","94% AV Level Silver Plan","93.00%","0.930178463459015","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$250","$500","10%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-01","Standard Silver On Exchange Plan","68.90%","0.688975691795349","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable","$2,100","$4,200","30%","$4,200","$8,400","50%","$8,400","$16,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-04","73% AV Level Silver Plan","72.70%","0.726758301258087","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$12,700","$25,400","Not Applicable","Not Applicable","$1,750","$3,500","30%","$3,500","$7,000","50%","$8,400","$16,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-05","87% AV Level Silver Plan","86.30%","0.864978551864624","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$12,700","$25,400","Not Applicable","Not Applicable","$500","$1,000","20%","$1,000","$2,000","40%","$8,400","$16,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-04","73% AV Level Silver Plan","73.87%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$3,000","$6,000","5%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$2,250","$4,000","$2,250","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$500","$1,000","5%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","10","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100012","Keystone DPOS Gold Premier","33871PA010",,"PAN001","PAS001","PAF015","New","POS","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100012-01","Standard Gold On Exchange Plan","81.93%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","11","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100013","Keystone DPOS Gold","33871PA010",,"PAN001","PAS001","PAF016","New","POS","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100013-01","Standard Gold On Exchange Plan","78.85%","0.788526117801666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","12","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100014","Keystone DPOS Silver Premier","33871PA010",,"PAN001","PAS001","PAF017","New","POS","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100014-01","Standard Silver On Exchange Plan","71.88%","0.718775689601898","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$250","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","13","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100015","Keystone DPOS Silver","33871PA010",,"PAN001","PAS001","PAF018","New","POS","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,"$125","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100015-01","Standard Silver On Exchange Plan","70.65%","0.706500768661499","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","2","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070004-01","Standard Bronze On Exchange Plan","61.97%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","2","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150002","Personal Choice PPO Platinum","31609PA015",,"PAN001","PAS001","PAF010","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150002-01","Standard Platinum On Exchange Plan","88.88%",,"No","No","No","100%",,"$2,000","$4,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","100%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","2","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","2","31609","PA","Individual","No","23-2184623","31609PA0070004","Personal Choice PPO Bronze","31609PA007",,"PAN001","PAS001","PAF005","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070004-03","Limited Cost Sharing Plan Variation","61.97%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0090001","Guardian Pediatric Advantage","32561PA009",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0090001-01","Standard High On Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0100001","Guardian Pediatric Essentials","32561PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0100001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","1","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0100001","Guardian Pediatric Essentials","32561PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0100001-01","Standard Low On Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","2","32561","PA","Individual","Yes","13-5123390","32561PA0180001","Guardian Family Advantage","32561PA018",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.25",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes",,,,,"32561PA0180001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","2","32561","PA","SHOP (Small Group)","Yes","13-5123390","32561PA0110001","Guardian Family Advantage Plus","32561PA011",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available out of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"32561PA0110001-00","Standard High Off Exchange Plan","85.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","32561","HIOS","4","2013-09-02 11:39:25","2","32561","PA","Individual","Yes","13-5123390","32561PA0200001","Guardian Family Essentials","32561PA020",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes",,,,,"32561PA0200001-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","4","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150004","Personal Choice PPO Gold","31609PA015",,"PAN001","PAS001","PAF012","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150004-01","Standard Gold On Exchange Plan","79.47%","0.794744968414307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$250","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","4","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070002-01","Standard Gold On Exchange Plan","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","4","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","4","31609","PA","Individual","No","23-2184623","31609PA0070002","Personal Choice PPO Gold","31609PA007",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070002-03","Limited Cost Sharing Plan Variation","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-01","Standard Silver On Exchange Plan","71.64%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150005","Personal Choice PPO Silver","31609PA015",,"PAN001","PAS001","PAF013","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,"$125","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150005-01","Standard Silver On Exchange Plan","70.70%","0.707028269767761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-03","Limited Cost Sharing Plan Variation","71.64%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-05","87% AV Level Silver Plan","86.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$20,000","$40,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","5","31609","PA","Individual","No","23-2184623","31609PA0070003","Personal Choice PPO Silver","31609PA007",,"PAN001","PAS001","PAF018","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070003-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-01","Standard Silver On Exchange Plan","68.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-03","Limited Cost Sharing Plan Variation","68.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-04","73% AV Level Silver Plan","73.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-04","73% AV Level Silver Plan","73.80%","0.738389074802399","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","20%","$1,450","$2,900","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-05","87% AV Level Silver Plan","87.40%","0.872379720211029","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$500","$1,000","20%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","2","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040001","Healthy Dental PPO Basic","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040001_2014.pdf",,"45127PA0040001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","2","45127","PA","Individual","Yes","45-5492167","45127PA0050001","Healthy Dental HMO Basic","45127PA005",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$11.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050001_2014.pdf",,"45127PA0050001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","3","45127","PA","Individual","Yes","45-5492167","45127PA0030002","Healthy Dental PPO Plan 2","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030002_2014.pdf",,"45127PA0030002-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","3","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040002","Healthy Dental PPO Classic","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040002_2014.pdf",,"45127PA0040002-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","3","45127","PA","Individual","Yes","45-5492167","45127PA0030002","Healthy Dental PPO Plan 2","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030002_2014.pdf",,"45127PA0030002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","3","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040002","Healthy Dental PPO Classic","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040002_2014.pdf",,"45127PA0040002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","4","45127","PA","Individual","Yes","45-5492167","45127PA0030003","Healthy Dental PPO Plan 3","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030003_2014.pdf",,"45127PA0030003-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","4","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040003","Healthy Dental PPO Classic Plus","45127PA004",,"PAN002","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.78",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040003_2014.pdf",,"45127PA0040003-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","4","45127","PA","Individual","Yes","45-5492167","45127PA0030003","Healthy Dental PPO Plan 3","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030003_2014.pdf",,"45127PA0030003-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","4","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040003","Healthy Dental PPO Classic Plus","45127PA004",,"PAN002","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.78",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040003_2014.pdf",,"45127PA0040003-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","5","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040004","Healthy Dental PPO Classic Enhanced","45127PA004",,"PAN002","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.78",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040004_2014.pdf",,"45127PA0040004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","5","45127","PA","Individual","Yes","45-5492167","45127PA0030004","Healthy Dental PPO Pediatric","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030004_2014.pdf",,"45127PA0030004-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","5","45127","PA","Individual","Yes","45-5492167","45127PA0030004","Healthy Dental PPO Pediatric","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030004_2014.pdf",,"45127PA0030004-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-05","87% AV Level Silver Plan","86.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","6","31609","PA","Individual","No","23-2184623","31609PA0070005","Personal Choice PPO Silver Reserve","31609PA007",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/pposilverreserve","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","31609PA0070005-06","94% AV Level Silver Plan","93.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","7","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150007","Personal Choice PPO Gold Premier HSA 25","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150007-01","Standard Gold On Exchange Plan","81.74%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","7","31609","PA","Individual","No","23-2184623","31609PA0070007","Personal Choice Catastrophic","31609PA007",,"PAN001","PAS001","PAF008","New","PPO","Catastrophic","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","3","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx4you.com/ffm/ppocatastrophic","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","31609PA0070007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","8","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150008","Personal Choice PPO Gold HSA","31609PA015",,"PAN001","PAS001","PAF014","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150008-01","Standard Gold On Exchange Plan","78.78%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","9","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150009","Personal Choice PPO Gold Premier HSA 50","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","Yes","$1,000.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150009-01","Standard Gold On Exchange Plan","78.42%","0.784221649169922","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","12","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150012","Personal Choice PPO Bronze Premier HSA","31609PA015",,"PAN001","PAS001","PAF016","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150012-01","Standard Bronze On Exchange Plan","61.89%","0.618927001953125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","13","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150013","Personal Choice PPO Bronze HSA","31609PA015",,"PAN001","PAS001","PAF017","New","PPO","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150013-01","Standard Bronze On Exchange Plan","60.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","14","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150014","Personal Choice PPO Platinum Premier HRA 50","31609PA015",,"PAN001","PAS001","PAF014","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Yes","$750.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150014-01","Standard Platinum On Exchange Plan","88.39%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","15","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150015","Personal Choice PPO Gold Premier HRA 25","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150015-01","Standard Gold On Exchange Plan","81.74%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","16","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150016","Personal Choice PPO Gold HRA","31609PA015",,"PAN001","PAS001","PAF014","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150016-01","Standard Gold On Exchange Plan","78.78%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","17","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150017","Personal Choice PPO Gold Premier HRA 50","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Yes","$1,000.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150017-01","Standard Gold On Exchange Plan","78.42%","0.784221649169922","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","18","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150018","Personal Choice PPO Silver Premier HRA 25","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150018-01","Standard Silver On Exchange Plan","70.89%","0.708896696567535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","HIOS","9","2014-01-17 09:36:20","19","31609","PA","SHOP (Small Group)","No","23-2184623","31609PA0150019","Personal Choice PPO Silver HRA","31609PA015",,"PAN001","PAS001","PAF015","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S.","Yes","www.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","31609PA0150019-01","Standard Silver On Exchange Plan","70.04%","0.700439751148224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0480001","Comprehensive Care EPO $1500 A Community Blue Plan","33709PA048",,"PAN001","PAS001","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard In network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0480001-01","Standard Gold On Exchange Plan","78.23%","0.782333493232727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0480002","Comprehensive Care EPO $1500 A Community Blue Plan","33709PA048",,"PAN001","PAS002","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard In network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0480002-01","Standard Gold On Exchange Plan","78.23%","0.782333493232727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","4","33906","PA","Individual","No","06-6033492","33906PA0070004","Aetna AdvantagePlus 5500 PD","33906PA007",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","4","33906","PA","Individual","No","06-6033492","33906PA0070004","Aetna AdvantagePlus 5500 PD","33906PA007",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","Individual","No","23-1294723","33709PA0420011","Flex Blue PPO 1000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998144828284007",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0480003","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS001","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard In network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0480003-01","Standard Silver On Exchange Plan","68.38%","0.683790028095245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-03","Limited Cost Sharing Plan Variation","68.90%","0.688975691795349","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable","$2,100","$4,200","30%","$4,200","$8,400","50%","$8,400","$16,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","2","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100002","Keystone HMO Platinum","33871PA010",,"PAN001","PAS001","PAF008","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100002-01","Standard Platinum On Exchange Plan","88.11%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420001","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997316941923383",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420001","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997316941923383",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420001-03","Limited Cost Sharing Plan Variation","62.00%","0.617553234100342","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%","$4,000","$8,000","60%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","6","33871","PA","Individual","No","23-2405376","33871PA0040006","Keystone HMO Silver Proactive","33871PA004",,"PAN001","PAS001","PAF006","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilverproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040006-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$2,250","$4,000","$2,250","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$100","$200","5%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","7","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100007","Keystone HMO Bronze","33871PA010",,"PAN001","PAS001","PAF012","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100007-01","Standard Bronze On Exchange Plan","61.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","8","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100010","Keystone DPOS Platinum Premier","33871PA010",,"PAN001","PAS001","PAF013","New","POS","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100010-01","Standard Platinum On Exchange Plan","90.72%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","9","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100011","Keystone DPOS Platinum","33871PA010",,"PAN001","PAS001","PAF014","New","POS","Platinum","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100011-01","Standard Platinum On Exchange Plan","88.11%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030005","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997657295754799",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030005-01","Standard Bronze On Exchange Plan","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","Individual","No","23-1294723","33709PA0420011","Flex Blue PPO 1000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998144828284007",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420011-03","Limited Cost Sharing Plan Variation","78.30%","0.782900393009186","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","1","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0480004","Comprehensive Care EPO $2000 A Community Blue Plan","33709PA048",,"PAN001","PAS002","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard In network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0480004-01","Standard Silver On Exchange Plan","68.38%","0.683790028095245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","Individual","No","23-1294723","33709PA0390011","Shared Cost Blue PPO 1000 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998121165651376",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390011-01","Standard Gold On Exchange Plan","78.00%","0.780146956443787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0490001","FLEX EPO $500/$1000 A Community Blue Plan","33709PA049",,"PAN001","PAS004","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide in network only","Yes","BlueCard in network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0490001-01","Standard Gold On Exchange Plan","81.98%","0.819923579692841","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0490002","FLEX EPO $500/$1000 A Community Blue Plan","33709PA049",,"PAN001","PAS005","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide in network only","Yes","BlueCard in network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0490002-01","Standard Gold On Exchange Plan","81.98%","0.819923579692841","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","Individual","No","23-1294723","33709PA0390011","Shared Cost Blue PPO 1000 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998121165651376",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","Individual","No","23-1294723","33709PA0390011","Shared Cost Blue PPO 1000 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998121165651376",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390011-03","Limited Cost Sharing Plan Variation","78.00%","0.780146956443787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0490003","FLEX EPO $1650 A Community Blue Plan","33709PA049",,"PAN001","PAS004","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide in network only","Yes","BlueCard in network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0490003-01","Standard Silver On Exchange Plan","69.02%","0.690577149391174","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","20%","$1,650","$3,300","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","2","33709","PA","SHOP (Small Group)","No","54-1637426","33709PA0490004","FLEX EPO $1650 A Community Blue Plan","33709PA049",,"PAN001","PAS005","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide in network only","Yes","BlueCard in network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"33709PA0490004-01","Standard Silver On Exchange Plan","69.02%","0.690577149391174","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","20%","$1,650","$3,300","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","3","33709","PA","Individual","No","23-1294723","33709PA0420009","Flex Blue PPO 1200 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.99809998769172",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420009-01","Standard Gold On Exchange Plan","78.90%","0.788626492023468","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable","$1,200","$2,400","20%","$2,400","$4,800","40%","$4,800","$9,600","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","3","33709","PA","Individual","No","23-1294723","33709PA0420009","Flex Blue PPO 1200 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.99809998769172",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","3","33709","PA","Individual","No","23-1294723","33709PA0420009","Flex Blue PPO 1200 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.99809998769172",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420009-03","Limited Cost Sharing Plan Variation","78.90%","0.788626492023468","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable","$1,200","$2,400","20%","$2,400","$4,800","40%","$4,800","$9,600","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","11","33709","PA","Individual","No","23-1294723","33709PA0410002","Major Events Blue PPO 6350","33709PA041",,"PAN003","PAS005","PAF002","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997041961841899",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0410002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-01","Standard Silver On Exchange Plan","68.40%","0.684232175350189","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-03","Limited Cost Sharing Plan Variation","68.40%","0.684232175350189","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-04","73% AV Level Silver Plan","72.30%","0.722554802894592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-05","87% AV Level Silver Plan","87.50%","0.874623596668243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","7","33906","PA","Individual","No","06-6033492","33906PA0070007","Aetna Premier 2000 PD","33906PA007",,"PAN001","PAS001","PAF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","7","33906","PA","Individual","No","06-6033492","33906PA0070007","Aetna Premier 2000 PD","33906PA007",,"PAN001","PAS001","PAF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-01","Standard Silver On Exchange Plan","69.50%","0.694995820522308","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,650","$5,300","30%",,,,"$5,300","$10,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-03","Limited Cost Sharing Plan Variation","69.50%","0.694995820522308","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,650","$5,300","30%",,,,"$5,300","$10,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-04","73% AV Level Silver Plan","72.80%","0.72766375541687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,300","$10,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-05","87% AV Level Silver Plan","87.50%","0.874626219272614","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$5,300","$10,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390005","Shared Cost Blue PPO 2650 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997614972515659",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390005-06","94% AV Level Silver Plan","94.10%","0.941447615623474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$5,300","$10,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390009","Shared Cost Blue PPO 1200 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998033015829305",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390009-01","Standard Gold On Exchange Plan","79.20%","0.790635049343109","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"$7,400","$14,800","Not Applicable","Not Applicable","$1,200","$2,400","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390009","Shared Cost Blue PPO 1200 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998033015829305",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","4","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100004","Keystone HMO Gold","33871PA010",,"PAN001","PAS001","PAF009","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100004-01","Standard Gold On Exchange Plan","78.84%","0.788443565368652","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040004-01","Standard Bronze On Exchange Plan","61.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","4","33871","PA","Individual","No","23-2405376","33871PA0040004","Keystone HMO Bronze","33871PA004",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmobronze","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040004-03","Limited Cost Sharing Plan Variation","61.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","2","52899","PA","SHOP (Small Group)","No","23-2813536","52899PA0020002","Small Business Advantage Standard Gold 1000","52899PA002",,"PAN005","PAS005","PAF010","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All except OB/GYN",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995105741599456",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard1000_Gold_Serv28_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard1000_Gold_Serv28_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0020002-01","Standard Gold On Exchange Plan","80.80%","0.824652075767517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$0","$200","$1,000","$1,200","$0","$80","4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","SHOP (Small Group)","No","23-2813536","52899PA0020003","Small Business Advantage Standard Silver 3000","52899PA002",,"PAN005","PAS005","PAF010","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All except OB/GYN",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994523064267936",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard3000_Silver_Serv28_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard3000_Silver_Serv28_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0020003-01","Standard Silver On Exchange Plan","71.70%","0.747530877590179","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$0","$200","$1,300","$1,200","$0","$80","4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","4","33709","PA","Individual","No","23-1294723","33709PA0390009","Shared Cost Blue PPO 1200 a Community Blue Plan","33709PA039",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.998033015829305",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390009-03","Limited Cost Sharing Plan Variation","79.20%","0.790635049343109","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"$7,400","$14,800","Not Applicable","Not Applicable","$1,200","$2,400","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-01","Standard Silver On Exchange Plan","68.90%","0.688801348209381","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,600","$11,200","$5,600","$11,200","$11,200","$22,400","Not Applicable","Not Applicable","$2,650","$5,300","30%","$5,300","$10,600","50%","$10,600","$21,200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-03","Limited Cost Sharing Plan Variation","68.90%","0.688801348209381","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,600","$11,200","$5,600","$11,200","$11,200","$22,400","Not Applicable","Not Applicable","$2,650","$5,300","30%","$5,300","$10,600","50%","$10,600","$21,200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-04","73% AV Level Silver Plan","73.20%","0.731913506984711","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$11,200","$22,400","Not Applicable","Not Applicable","$1,500","$3,000","30%","$3,000","$6,000","50%","$10,600","$21,200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-05","87% AV Level Silver Plan","86.60%","0.869089484214783","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$11,200","$22,400","Not Applicable","Not Applicable","$400","$800","20%","$800","$1,600","50%","$10,600","$21,200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","5","33709","PA","Individual","No","23-1294723","33709PA0420005","Flex Blue PPO 2650 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997695481900084",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420005-06","94% AV Level Silver Plan","93.20%","0.934166848659515","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","$11,200","$22,400","Not Applicable","Not Applicable","$100","$200","10%","$200","$400","40%","$10,600","$21,200","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-01","Standard Silver On Exchange Plan","69.20%","0.692110180854797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,100","$4,200","30%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","6","33709","PA","Individual","No","23-1294723","33709PA0390007","Shared Cost Blue PPO 2100 a Community Blue Plan","33709PA039",,"PAN001","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997756509890381",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0390007-03","Limited Cost Sharing Plan Variation","69.20%","0.692110180854797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,100","$4,200","30%",,,,"$4,200","$8,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","7","33709","PA","Individual","No","23-1294723","33709PA0420007","Flex Blue PPO 2100 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997759276974249",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420007-06","94% AV Level Silver Plan","94.20%","0.9424649477005","No","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%","$200","$400","30%","$8,400","$16,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420001","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS004","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997316941923383",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420001-01","Standard Bronze On Exchange Plan","62.00%","0.617553234100342","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%","$4,000","$8,000","60%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420003","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997431379165988",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420003-01","Standard Bronze On Exchange Plan","62.00%","0.619918048381805","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%","$4,000","$8,000","60%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","8","33709","PA","Individual","No","23-1294723","33709PA0420003","Flex Blue PPO 4000 a Community Blue Plan","33709PA042",,"PAN002","PAS005","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997431379165988",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0420003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430001","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN002","PAS004","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997772707271639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430001-06","94% AV Level Silver Plan","94.80%","0.949837803840637","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%","$100","$200","20%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-01","Standard Silver On Exchange Plan","72.00%","0.719636201858521","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%","$1,700","$3,400","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","10","33709","PA","Individual","No","23-1294723","33709PA0430003","Health Savings Blue PPO 1700 a Community Blue Plan","33709PA043",,"PAN001","PAS005","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997874342704251",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","No","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0430003-03","Limited Cost Sharing Plan Variation","72.00%","0.719636201858521","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,550","$9,100","$4,550","$9,100","$9,100","$18,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%","$1,700","$3,400","30%","$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","11","33709","PA","Individual","No","23-1294723","33709PA0380002","Major Events Blue PPO 6350 a Community Blue plan","33709PA038",,"PAN001","PAS002","PAF002","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997016594121175",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0380002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","11","33709","PA","Individual","No","23-1294723","33709PA0410001","Major Events Blue PPO 6350","33709PA041",,"PAN003","PAS004","PAF002","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.996936663996459",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0410001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33709","HIOS","8","2014-03-19 07:06:49","12","33709","PA","Individual","No","23-1294723","33709PA0400001","Health Savings Blue PPO 2750 a Community Blue Plan","33709PA040",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997516056829639",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"33709PA0400001-06","94% AV Level Silver Plan","94.10%","0.941233038902283","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","1","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100001","Keystone HMO Platinum Premier","33871PA010",,"PAN001","PAS001","PAF007","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100001-01","Standard Platinum On Exchange Plan","90.72%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF001","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","33871PA0040001-01","Standard Platinum On Exchange Plan","88.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF001","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","33871PA0040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","1","33871","PA","Individual","No","23-2405376","33871PA0040001","Keystone HMO Platinum","33871PA004",,"PAN001","PAS001","PAF001","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,,"5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmoplatinum","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary","33871PA0040001-03","Limited Cost Sharing Plan Variation","88.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","2","33871","PA","Individual","No","23-2405376","33871PA0040002","Keystone HMO Gold","33871PA004",,"PAN001","PAS001","PAF002","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogold","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040002-01","Standard Gold On Exchange Plan","82.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-01","Standard Silver On Exchange Plan","69.84%","0.6984041929245","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-03","Limited Cost Sharing Plan Variation","69.84%","0.6984041929245","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-04","73% AV Level Silver Plan","72.35%","0.723524689674377","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-05","87% AV Level Silver Plan","86.69%","0.86685174703598","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","3","33871","PA","Individual","No","23-2405376","33871PA0040003","Keystone HMO Silver","33871PA004",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$250","0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmosilver","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040003-06","94% AV Level Silver Plan","93.22%","0.932190179824829","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","5","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100005","Keystone HMO Silver Premier","33871PA010",,"PAN001","PAS001","PAF010","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","Referrals are required for all services excepts: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Partcipating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100005-01","Standard Silver On Exchange Plan","71.74%","0.717431128025055","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","5","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogoldproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040005-01","Standard Gold On Exchange Plan","79.79%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","5","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogoldproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040005-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","5","33871","PA","Individual","No","23-2405376","33871PA0040005","Keystone HMO Gold Proactive","33871PA004",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","Referrals are required for all services except: Emergency Services, OB/GYN, Mammograms, Inpatient Hospital Services, Dialysis services performed in a Participating Facility or by a Participating Professional Provider, Nutrition Counseling and Diabetic Education Program","Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","www.ibx4you.com/ffm/hmogoldproactive","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/brochure","www.ibx.com/ffm/formulary2","33871PA0040005-03","Limited Cost Sharing Plan Variation","79.79%",,"No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33871","HIOS","7","2013-10-15 07:27:56","14","33871","PA","SHOP (Small Group)","No","23-2405376","33871PA0100016","Keystone DPOS Bronze","33871PA010",,"PAN001","PAS001","PAF019","New","POS","Bronze","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care, Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine foot care, Weight Loss programs, Non-emergency care when traveling outside the U.S., Most coverage provided outside the U.S.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990685212365082",,,"0","0","0","2014-01-01",,"Yes","Emergent, Urgent and Follow-up Care","Yes","Emergent, Urgent and Follow-up Care","No","wwww.ibx.com/ffm/shop","www.ibx.com/market/SHOP","www.ibx.com/ffm/shop/brochure","www.ibx.com/ffm/formulary2","33871PA0100016-01","Standard Bronze On Exchange Plan","61.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$40,000","$80,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","1","33906","PA","Individual","No","06-6033492","33906PA0070001","Aetna Advantage 5750 PD","33906PA007",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998612368483754",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","1","33906","PA","Individual","No","06-6033492","33906PA0070001","Aetna Advantage 5750 PD","33906PA007",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998612368483754",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","1","33906","PA","Individual","No","06-6033492","33906PA0070001","Aetna Advantage 5750 PD","33906PA007",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998612368483754",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","2","33906","PA","Individual","No","06-6033492","33906PA0070002","Aetna Advantage 6350","33906PA007",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","2","33906","PA","Individual","No","06-6033492","33906PA0070002","Aetna Advantage 6350","33906PA007",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","2","33906","PA","Individual","No","06-6033492","33906PA0070002","Aetna Advantage 6350","33906PA007",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","4","33906","PA","Individual","No","06-6033492","33906PA0070004","Aetna AdvantagePlus 5500 PD","33906PA007",,"PAN001","PAS001","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","5","33906","PA","Individual","No","06-6033492","33906PA0070008","Aetna Classic 5000","33906PA007",,"PAN001","PAS001","PAF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","7","33906","PA","Individual","No","06-6033492","33906PA0070007","Aetna Premier 2000 PD","33906PA007",,"PAN001","PAS001","PAF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","33906","HIOS","6","2013-09-17 16:07:07","8","33906","PA","Individual","No","06-6033492","33906PA0070005","Aetna Basic","33906PA007",,"PAN001","PAS001","PAF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998586938453931",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","33906PA0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","1","45127","PA","Individual","Yes","45-5492167","45127PA0030001","Healthy Dental PPO Plan 1","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030001_2014.pdf",,"45127PA0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","1","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0060001","Healthy Dental HMO Basic","45127PA006",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$11.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060001_2014.pdf",,"45127PA0060001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","1","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0060001","Healthy Dental HMO Basic","45127PA006",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$11.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060001_2014.pdf",,"45127PA0060001-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","1","45127","PA","Individual","Yes","45-5492167","45127PA0030001","Healthy Dental PPO Plan 1","45127PA003",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.75",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0030001_2014.pdf",,"45127PA0030001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","2","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040001","Healthy Dental PPO Basic","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040001_2014.pdf",,"45127PA0040001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","2","45127","PA","Individual","Yes","45-5492167","45127PA0050001","Healthy Dental HMO Basic","45127PA005",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$11.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050001_2014.pdf",,"45127PA0050001-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","5","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040004","Healthy Dental PPO Classic Enhanced","45127PA004",,"PAN002","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.78",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040004_2014.pdf",,"45127PA0040004-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","6","45127","PA","Individual","Yes","45-5492167","45127PA0050002","Healthy Dental HMO Pediatric 702xs","45127PA005",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050002_2014.pdf",,"45127PA0050002-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","6","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040005","Healthy Dental PPO Value 75","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040005_2014.pdf",,"45127PA0040005-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","6","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040005","Healthy Dental PPO Value 75","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040005_2014.pdf",,"45127PA0040005-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","6","45127","PA","Individual","Yes","45-5492167","45127PA0050002","Healthy Dental HMO Pediatric 702xs","45127PA005",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0050002_2014.pdf",,"45127PA0050002-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","7","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040006","Healthy Dental PPO Pediatric","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040006_2014.pdf",,"45127PA0040006-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","7","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040006","Healthy Dental PPO Pediatric","45127PA004",,"PAN002","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040006_2014.pdf",,"45127PA0040006-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","8","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0040007","Healthy Dental PPO Pediatric Plus","45127PA004",,"PAN002","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$12.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Standard PPO Coverage","Yes","Standard PPO Coverage","Yes",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0040007_2014.pdf",,"45127PA0040007-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","9","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0060002","Healthy Dental HMO Classic","45127PA006",,"PAN001","PAS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$11.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060002_2014.pdf",,"45127PA0060002-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","10","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0060003","Healthy Dental HMO Pediatric 702xs","45127PA006",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060003_2014.pdf",,"45127PA0060003-00","Standard Low Off Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","45127","HIOS","6","2013-11-26 13:14:08","10","45127","PA","SHOP (Small Group)","Yes","45-5492167","45127PA0060003","Healthy Dental HMO Pediatric 702xs","45127PA006",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency","Yes","Emergency","No",,,"www.capbluecross.com/pdf/benefits_summary/dental/45127PA0060003_2014.pdf",,"45127PA0060003-01","Standard Low On Exchange Plan","68.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020001",,"46518PA0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","Individual","Yes","75-1233841","46518PA0010001","Dentegra Dental PPO Children's Plan 70","46518PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010001",,"46518PA0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","Individual","Yes","75-1233841","46518PA0010001","Dentegra Dental PPO Children's Plan 70","46518PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010001",,"46518PA0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020001",,"46518PA0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","Individual","Yes","75-1233841","46518PA0010002","Dentegra Dental PPO Children's Plan 85","46518PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.90",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/pa/46518pa0010002",,"46518PA0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","46518","HIOS","6","2014-01-17 09:36:20","1","46518","PA","SHOP (Small Group)","Yes","75-1233841","46518PA0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","46518PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/pa/46518pa0020002",,"46518PA0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-04","73% AV Level Silver Plan","73.90%","0.737608551979065","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,300","$400","$400","$200","$1,600","$1,100","$0","$80","34"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-05","87% AV Level Silver Plan","86.60%","0.865523278713226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$300","$600","$200","$500","$800","$400","$80","35"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","4","52899","PA","Individual","No","23-2813536","52899PA0030042","UPMC Advantage Secure Select","52899PA003",,"PAN004","PAS004","PAF007","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995779496048354",,"$500","0","0","3","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030042-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-01","Standard Silver On Exchange Plan","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$50","$700","$600","$80","4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$300","$600","$80","5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-03","Limited Cost Sharing Plan Variation","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$2,000","$1,000","$0","$80","6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030007","UPMC Advantage Enhanced Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998243129431998",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030007","UPMC Advantage Enhanced Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998243129431998",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030007-03","Limited Cost Sharing Plan Variation","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","21"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-04","73% AV Level Silver Plan","73.60%","0.736023426055908","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,250","$8,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$0","$0","$0","$0","7"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-05","87% AV Level Silver Plan","87.60%","0.882350385189056","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$0","$200","$2,000","$1,000","$0","$80","8"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030051","UPMC Advantage Value Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998304107510352",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030051-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0",,,,,"38"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030051","UPMC Advantage Value Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998304107510352",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030051-03","Limited Cost Sharing Plan Variation","81.50%","0.810366690158844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"39"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-05","87% AV Level Silver Plan","86.60%","0.865523278713226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$300","$600","$200","$500","$800","$400","$80","17"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-06","94% AV Level Silver Plan","94.80%","0.947607934474945","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$500","$200","$50","$300","$400","$80","18"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030007","UPMC Advantage Enhanced Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998243129431998",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030007-01","Standard Gold On Exchange Plan","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","19"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$300","$600","$80","11"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-03","Limited Cost Sharing Plan Variation","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$2,000","$1,000","$0","$80","12"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030037","UPMC Advantage Enhanced Gold Select","52899PA003",,"PAN004","PAS003","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998118749572989",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030037-01","Standard Gold On Exchange Plan","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","37"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030037","UPMC Advantage Enhanced Gold Select","52899PA003",,"PAN004","PAS003","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998118749572989",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030037-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"38"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030037","UPMC Advantage Enhanced Gold Select","52899PA003",,"PAN004","PAS003","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998118749572989",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030037-03","Limited Cost Sharing Plan Variation","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","39"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-01","Standard Silver On Exchange Plan","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","31"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","Not Applicable","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-03","Limited Cost Sharing Plan Variation","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","33"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0090002","Smile for Health Family C60A70","49275PA009",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a70-ppo.pdf",,,,"49275PA0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","7","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0110001","Smile for Health Child C60A80","49275PA011",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","7","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0110002","Smile for Health Family C60A80","49275PA011",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","5","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0100001","Smile for Health Child C60A60","49275PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a60-ppo.pdf",,,,"49275PA0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","5","49275","PA","Individual","Yes","23-1661402","49275PA0180001","Smile for Health Child C80","49275PA018",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-pa-idental",,,"49275PA0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","5","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0100001","Smile for Health Child C60A60","49275PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a60-ppo.pdf",,,,"49275PA0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-03","Limited Cost Sharing Plan Variation","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","15"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-04","73% AV Level Silver Plan","73.90%","0.737608551979065","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,300","$400","$400","$200","$1,600","$1,100","$0","$80","16"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030005","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997657295754799",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030005","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997657295754799",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030005-03","Limited Cost Sharing Plan Variation","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030014","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN002","PAS002","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99767573121956",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030014-01","Standard Bronze On Exchange Plan","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","7"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030014","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN002","PAS002","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99767573121956",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030014","UPMC Advantage Enhanced Bronze","52899PA003",,"PAN002","PAS002","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99767573121956",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030014-03","Limited Cost Sharing Plan Variation","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","9"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030033","UPMC Advantage Enhanced Bronze Select","52899PA003",,"PAN004","PAS004","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997492098584555",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030033-01","Standard Bronze On Exchange Plan","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","13"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0050001","BlueCare PPO","55957PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0050001-01","Standard Silver On Exchange Plan","70.00%","0.703885912895203","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,250","$2,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$150","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,300","$200","$1,800","$150","$1,400","$320","$12","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0160001","myBlue Choice LP $5,500","55957PA016",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700062000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0160001-01","Standard Bronze On Exchange Plan","60.10%","0.600866973400116","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$2,170","$0","$0","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0050002","BlueCare PPO","55957PA005",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0050002-00","Standard Gold Off Exchange Plan","79.10%","0.810464203357697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$100","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,050","$0","$1,250","$150","$1,100","$80","$68","$105","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0160001","myBlue Choice LP $5,500","55957PA016",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700062000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0160001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030009","UPMC Advantage Goals Gold","52899PA003",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998288079440287",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030009-01","Standard Gold On Exchange Plan","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","4"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-05","87% AV Level Silver Plan","86.98%","0.869839251041412","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%","$0","$0","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$100","$0","$80","34"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-06","94% AV Level Silver Plan","94.14%","0.941377282142639","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","8%","$0","$0","8%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$40","$0","$80","35"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030035","UPMC Advantage Enhanced Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997924248551827",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030035-06","94% AV Level Silver Plan","94.80%","0.947607934474945","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$500","$200","$50","$300","$400","$80","36"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","1","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0150001","Smile for Health Child C80A80","49275PA015",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c80a80-ppo.pdf",,,,"49275PA0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","1","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0150002","Smile for Health Family C80A80","49275PA015",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c80a80-ppo.pdf",,,,"49275PA0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","1","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0150002","Smile for Health Family C80A80","49275PA015",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c80a80-ppo.pdf",,,,"49275PA0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","Individual","Yes","23-1661402","49275PA0010002","Smile for Health Family C60A70","49275PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0120001","Smile for Health Child C60A50","49275PA012",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a50-ppo.pdf",,,,"49275PA0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0120001","Smile for Health Child C60A50","49275PA012",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a50-ppo.pdf",,,,"49275PA0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","Individual","Yes","23-1661402","49275PA0010002","Smile for Health Family C60A70","49275PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0120002","Smile for Health Family C60A50","49275PA012",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a50-ppo.pdf",,,,"49275PA0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","Individual","Yes","23-1661402","49275PA0010001","Smile for Health Child C60A70","49275PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0120002","Smile for Health Family C60A50","49275PA012",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a50-ppo.pdf",,,,"49275PA0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","2","49275","PA","Individual","Yes","23-1661402","49275PA0010001","Smile for Health Child C60A70","49275PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","3","49275","PA","Individual","Yes","23-1661402","49275PA0020001","Smile for Health Child C60A60","49275PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","3","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0190001","Smile for Health Child C60","49275PA019",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.35",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","3","49275","PA","Individual","Yes","23-1661402","49275PA0020001","Smile for Health Child C60A60","49275PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","3","49275","PA","Individual","Yes","23-1661402","49275PA0020002","Smile for Health Family C60A60","49275PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","3","49275","PA","Individual","Yes","23-1661402","49275PA0020002","Smile for Health Family C60A60","49275PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","4","49275","PA","Individual","Yes","23-1661402","49275PA0040001","Smile for Health Child C60A50","49275PA004",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-pa-idental",,,"49275PA0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","4","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0200001","Smile for Health Child C80","49275PA020",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","4","49275","PA","Individual","Yes","23-1661402","49275PA0040002","Smile For Health Family C60A50","49275PA004",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-pa-idental",,,"49275PA0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","5","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0100002","Smile for Health Family C60A60","49275PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a60-ppo.pdf",,,,"49275PA0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","5","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0100002","Smile for Health Family C60A60","49275PA010",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a60-ppo.pdf",,,,"49275PA0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0090001","Smile for Health Child C60A70","49275PA009",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a70-ppo.pdf",,,,"49275PA0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","Individual","Yes","23-1661402","49275PA0070001","Smile for Health Child C80A80","49275PA007",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","Individual","Yes","23-1661402","49275PA0070001","Smile for Health Child C80A80","49275PA007",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0090001","Smile for Health Child C60A70","49275PA009",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-c60a70-ppo.pdf",,,,"49275PA0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","Individual","Yes","23-1661402","49275PA0070002","Smile for Health Family C80A80","49275PA007",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0090002","Smile for Health Family C60A70","49275PA009",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-c60a70-ppo.pdf",,,,"49275PA0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","6","49275","PA","Individual","Yes","23-1661402","49275PA0070002","Smile for Health Family C80A80","49275PA007",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-pa-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2",,,"49275PA0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","8","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0130001","Smile for Health Child C80A70","49275PA013",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","8","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0130002","Smile for Health Family C80A70","49275PA013",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","9","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0140001","Smile for Health Child C80A60","49275PA014",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-01","Standard Silver On Exchange Plan","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$50","$700","$600","$80","10"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-04","73% AV Level Silver Plan","73.60%","0.736023426055908","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,250","$8,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$0","$0","$0","$0","13"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","4","52899","PA","Individual","No","23-2813536","52899PA0030021","UPMC Advantage Secure","52899PA003",,"PAN001","PAS001","PAF007","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996054676601714",,"$500","0","0","3","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","4","52899","PA","Individual","No","23-2813536","52899PA0030022","UPMC Advantage Secure","52899PA003",,"PAN002","PAS002","PAF007","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996106682512423",,"$500","0","0","3","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Basic_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030022-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100003","Healthy Benefits HMO 4000.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml6",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100003-03","Limited Cost Sharing Plan Variation","62.00%","0.65227484703064","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","24"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110003","Healthy Benefits Value HMO 4000.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml7",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110003-01","Standard Bronze On Exchange Plan","62.00%","0.65227484703064","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","25"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110003","Healthy Benefits Value HMO 4000.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml7",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","26"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110003","Healthy Benefits Value HMO 4000.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml7",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110003-03","Limited Cost Sharing Plan Variation","62.00%","0.65227484703064","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","27"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100004","Healthly Benefits HMO 6350.0","53789PA010",,"PAN002","PAS002","PAF005","New","HMO","Catastrophic","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000401_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml8",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$300","$3,000","$0","$80","28"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110004","Healthly Benefits Value HMO 6350.0","53789PA011",,"PAN001","PAS001","PAF005","New","HMO","Catastrophic","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000401_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml9",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$300","$3,000","$0","$80","29"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030041","UPMC Advantage Goals Gold Select","52899PA003",,"PAN004","PAS004","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998166844996797",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030041-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","9","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0140002","Smile for Health Child C80A60","49275PA014",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","10","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0160001","Smile for Health Child C80A50","49275PA016",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","10","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0160002","Smile for Health Family C80A50","49275PA016",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","11","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0210001","Smile for Health Child C40","49275PA021",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$11.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0210001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","12","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0220001","Smile for Health Child C40A50","49275PA022",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$11.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0220001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","12","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0220002","Smile for Health Family C40A50","49275PA022",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$11.39",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0220002-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","13","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0230001","Smile for Health Child C60NEPA3","49275PA023",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","0001-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0230001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","13","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0230002","Smile for Health Family C60NEPA3","49275PA023",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0230002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","14","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0240001","Smile for Health Child C60NEPA4","49275PA024",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0240001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","49275","HIOS","7","2014-01-21 08:29:49","14","49275","PA","SHOP (Small Group)","Yes","23-1661402","49275PA0240002","Smile for Health Family C60NEPA4","49275PA024",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"49275PA0240002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-01","Standard Silver On Exchange Plan","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","SHOP (Small Group)","No","23-2813536","52899PA0020001","Small Business Advantage Standard Platinum","52899PA002",,"PAN005","PAS005","PAF009","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All except OB/GYN",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995693990629459",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services Only","Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard_Platinum_Serv28_Net9","https://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=SHOP_HMO_Standard_Platinum_Serv28_Net9","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0020001-01","Standard Platinum On Exchange Plan","91.70%","0.925014793872833","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,300","$0","$200","$0","$1,300","$0","$80","4"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","Not Applicable","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-03","Limited Cost Sharing Plan Variation","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","6"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-04","73% AV Level Silver Plan","73.90%","0.737608551979065","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,300","$400","$400","$200","$1,600","$1,100","$0","$80","7"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-05","87% AV Level Silver Plan","86.60%","0.865523278713226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$300","$600","$200","$500","$800","$400","$80","8"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030047","UPMC Advantage Enhanced Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998073972253987",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030047-06","94% AV Level Silver Plan","94.80%","0.947607934474945","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$500","$200","$50","$300","$400","$80","9"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030013","UPMC Advantage Enhanced Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99825351796366",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030013-01","Standard Gold On Exchange Plan","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","10"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030013","UPMC Advantage Enhanced Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99825351796366",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030013","UPMC Advantage Enhanced Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99825351796366",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency medical services only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030013-03","Limited Cost Sharing Plan Variation","79.10%","0.79023551940918","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$400","$600","$200","$1,000","$1,100","$100","$80","12"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-01","Standard Silver On Exchange Plan","71.60%","0.713695049285889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$400","$400","$200","$1,300","$1,100","$0","$80","13"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","1","52899","PA","Individual","No","23-2813536","52899PA0030006","UPMC Advantage Enhanced Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998061330228685",,"$500","0","0","0","2014-01-01","2014-12-31","Yes","Emergency medical services only","No",,"No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","Not Applicable","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030033","UPMC Advantage Enhanced Bronze Select","52899PA003",,"PAN004","PAS004","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997492098584555",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","3","52899","PA","Individual","No","23-2813536","52899PA0030033","UPMC Advantage Enhanced Bronze Select","52899PA003",,"PAN004","PAS004","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997492098584555",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Enhanced_Bronze_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030033-03","Limited Cost Sharing Plan Variation","59.20%","0.590768098831177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10","$200","$200","$4,200","$700","$0","$80","15"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030002","UPMC Advantage Value Silver","52899PA003",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998055965783088",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030002-06","94% AV Level Silver Plan","94.90%","0.949566900730133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$200","$1,300","$1,000","$0","$80","9"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030041","UPMC Advantage Goals Gold Select","52899PA003",,"PAN004","PAS004","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998166844996797",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030041-03","Limited Cost Sharing Plan Variation","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","15"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100001","Healthy Benefits HMO 500.0","53789PA010",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100001-01","Standard Gold On Exchange Plan","79.50%","0.795036554336548","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","4"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070003","Healthy Benefits HMO 500.0 EX","53789PA007",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000300_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0070003-01","Standard Gold On Exchange Plan","79.50%","0.797237157821655","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","4"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100001","Healthy Benefits HMO 500.0","53789PA010",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080003","Healthy Benefits Value HMO 500.0 EX","53789PA008",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000300_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0080003-01","Standard Gold On Exchange Plan","79.50%","0.797237157821655","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","5"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100001","Healthy Benefits HMO 500.0","53789PA010",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100001-03","Limited Cost Sharing Plan Variation","79.50%","0.795036554336548","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","6"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110001","Healthy Benefits Value HMO 500.0","53789PA011",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml3",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110001-01","Standard Gold On Exchange Plan","79.50%","0.795036554336548","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","7"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-01","Standard Silver On Exchange Plan","71.31%","0.713128089904785","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","36"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","37"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-03","Limited Cost Sharing Plan Variation","71.31%","0.713128089904785","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","38"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-04","73% AV Level Silver Plan","73.79%","0.737896263599396","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","49%","$0","$0","49%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","39"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-05","87% AV Level Silver Plan","87.60%","0.882350385189056","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$0","$200","$2,000","$1,000","$0","$80","14"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-05","87% AV Level Silver Plan","87.93%","0.879281103610992","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%","$200","$400","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$20","$200","$0","$200","$200","$1,200","$0","$80","20"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-06","94% AV Level Silver Plan","93.60%","0.936010897159576","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","21"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100003","Healthy Benefits HMO 4000.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml6",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100003-01","Standard Bronze On Exchange Plan","62.00%","0.65227484703064","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","22"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100003","Healthy Benefits HMO 4000.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000301_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml6",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","23"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030017","UPMC Advantage Value Silver","52899PA003",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998068677638689",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030017-06","94% AV Level Silver Plan","94.90%","0.949566900730133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$200","$1,300","$1,000","$0","$80","15"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-01","Standard Silver On Exchange Plan","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$0","$0","$0","$0","22"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$1,000","$1,000","$100","$80","23"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-03","Limited Cost Sharing Plan Variation","71.50%","0.712826788425446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$1,000","$1,000","$100","$80","24"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-04","73% AV Level Silver Plan","73.60%","0.736023426055908","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,250","$8,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$200","$0","$200","$0","$0","$0","$0","25"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-05","87% AV Level Silver Plan","87.60%","0.882350385189056","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$50","$200","$0","$200","$1,000","$1,000","$100","$80","26"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030027","UPMC Advantage Value Silver Select","52899PA003",,"PAN004","PAS004","PAF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997918509787637",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Silver_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030027-06","94% AV Level Silver Plan","94.90%","0.949566900730133","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$100","$0","$200","$1,000","$1,000","$100","$80","27"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030049","UPMC Advantage Value Gold Select","52899PA003",,"PAN004","PAS004","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998173515752489",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030049-01","Standard Gold On Exchange Plan","81.50%","0.78349781036377","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"31"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030049","UPMC Advantage Value Gold Select","52899PA003",,"PAN004","PAS004","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998173515752489",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030049-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0",,,,,"32"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030049","UPMC Advantage Value Gold Select","52899PA003",,"PAN004","PAS004","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998173515752489",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030049-03","Limited Cost Sharing Plan Variation","81.50%","0.91135162115097","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"33"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030050","UPMC Advantage Value Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998294313789241",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030050-01","Standard Gold On Exchange Plan","81.50%","0.810366690158844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"34"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030050","UPMC Advantage Value Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998294313789241",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030050-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0",,,,,"35"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030050","UPMC Advantage Value Gold","52899PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998294313789241",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030050-03","Limited Cost Sharing Plan Variation","81.50%","0.810366690158844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"36"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","5","52899","PA","Individual","No","23-2813536","52899PA0030051","UPMC Advantage Value Gold","52899PA003",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998304107510352",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Value_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030051-01","Standard Gold On Exchange Plan","81.50%","0.810366690158844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$200","$0","$200",,,,,"37"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030009","UPMC Advantage Goals Gold","52899PA003",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998288079440287",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030009","UPMC Advantage Goals Gold","52899PA003",,"PAN001","PAS001","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998288079440287",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv5_Net1","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030009-03","Limited Cost Sharing Plan Variation","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","6"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-01","Standard Silver On Exchange Plan","71.31%","0.713128089904785","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","30"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","31"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-03","Limited Cost Sharing Plan Variation","71.31%","0.713128089904785","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","32"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100005","Healthy Benefits HMO 0.50","53789PA010",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml10",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100005-04","73% AV Level Silver Plan","73.79%","0.737896263599396","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","49%","$0","$0","49%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","33"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030011","UPMC Advantage Goals Gold","52899PA003",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998297944678056",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030011-01","Standard Gold On Exchange Plan","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","4","55957","PA","Individual","No","23-2905083","55957PA0180002","myBlue Choice $1,000","55957PA018",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180002-00","Standard Gold Off Exchange Plan","79.00%","0.789892137050629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,260","$150","$1,000","$160","$88","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","4","55957","PA","Individual","No","23-2905083","55957PA0180002","myBlue Choice $1,000","55957PA018",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180002-01","Standard Gold On Exchange Plan","79.00%","0.789892137050629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,260","$150","$1,000","$160","$88","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","4","55957","PA","Individual","No","23-2905083","55957PA0180002","myBlue Choice $1,000","55957PA018",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","4","55957","PA","Individual","No","23-2905083","55957PA0180002","myBlue Choice $1,000","55957PA018",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700068000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180002-03","Limited Cost Sharing Plan Variation","79.00%","0.789892137050629","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,260","$150","$1,000","$160","$88","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","5","55957","PA","Individual","No","23-2905083","55957PA0190002","myBlue Access $750","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190002-00","Standard Gold Off Exchange Plan","78.50%","0.784565389156342","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$750","$1,500","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$0","$655","$150","$750","$160","$69","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","5","55957","PA","Individual","No","23-2905083","55957PA0190002","myBlue Access $750","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190002-01","Standard Gold On Exchange Plan","78.50%","0.784565389156342","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$750","$1,500","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$0","$655","$150","$750","$160","$69","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","5","55957","PA","Individual","No","23-2905083","55957PA0190002","myBlue Access $750","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","5","55957","PA","Individual","No","23-2905083","55957PA0190002","myBlue Access $750","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700069000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190002-03","Limited Cost Sharing Plan Variation","78.50%","0.784565389156342","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$750","$1,500","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$0","$655","$150","$750","$160","$69","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-00","Standard Silver Off Exchange Plan","71.90%","0.719363152980804","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$3,000","$6,000","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$630","$150","$1,000","$140","$44","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-01","Standard Silver On Exchange Plan","71.90%","0.719363152980804","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$3,000","$6,000","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$630","$150","$1,000","$140","$44","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-03","Limited Cost Sharing Plan Variation","71.90%","0.719363152980804","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$6,350","$12,700","$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$3,000","$6,000","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$630","$150","$1,000","$140","$44","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-04","73% AV Level Silver Plan","73.90%","0.737691462039948","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$5,200","$10,400","$10,000","$20,000","Not Applicable","Not Applicable","$750","$1,500","10%","$3,000","$6,000","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-05","87% AV Level Silver Plan","87.10%","0.871257781982422","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$500","$1,000","$1,500","$3,000","$10,000","$20,000","Not Applicable","Not Applicable","$400","$800","10%","$500","$1,000","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030011","UPMC Advantage Goals Gold","52899PA003",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998297944678056",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030011","UPMC Advantage Goals Gold","52899PA003",,"PAN002","PAS002","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998297944678056",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Dental Services and Emergency Medical Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv23_Net2","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030011-03","Limited Cost Sharing Plan Variation","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","9"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070001","Healthy Benefits HMO 4000.50 EX","53789PA007",,"PAN002","PAS002","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000100_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0070001-01","Standard Bronze On Exchange Plan","62.00%","0.662077665328979","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","4"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0070002","Healthy Benefits HMO 0.50 EX","53789PA007",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA007000200_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0070002-01","Standard Silver On Exchange Plan","71.25%","0.721789717674255","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","5"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080001","Healthy Benefits Value HMO 4000.50 EX","53789PA008",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000100_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0080001-01","Standard Bronze On Exchange Plan","62.00%","0.662077665328979","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%","$4,000","$8,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$4,300","$200","$0","$80","6"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","2","53789","PA","SHOP (Small Group)","No","23-2399845","53789PA0080002","Healthy Benefits Value HMO 0.50 EX","53789PA008",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","https://www.capbluecross.com/pdf/benefits_summary/sg/53789PA008000200_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0080002-01","Standard Silver On Exchange Plan","71.25%","0.721789717674255","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0050001","BlueCare PPO","55957PA005",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2S0000002&rxid=RXRIDERHCR-SC00000007&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0050001-00","Standard Silver Off Exchange Plan","70.00%","0.703885912895203","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,250","$2,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$150","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,300","$200","$1,800","$150","$1,400","$320","$12","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0160001","myBlue Choice LP $5,500","55957PA016",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700062000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0160001-00","Standard Bronze Off Exchange Plan","60.10%","0.600866973400116","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$2,170","$0","$0","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","SHOP (Small Group)","No","23-2905083","55957PA0050002","BlueCare PPO","55957PA005",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?healthproductid=PPOHCR-S2G0000013&rxid=RXRIDERHCR-SC00000003&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0050002-01","Standard Gold On Exchange Plan","79.10%","0.810464203357697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$100","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,050","$0","$1,250","$150","$1,100","$80","$68","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0160001","myBlue Choice LP $5,500","55957PA016",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700062000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0160001-03","Limited Cost Sharing Plan Variation","60.10%","0.600866973400116","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$5,500","$0","$0","$150","$2,170","$0","$0","$105","7"
"2014","PA","52899","HIOS","11","2014-03-19 07:06:49","7","52899","PA","Individual","No","23-2813536","52899PA0030041","UPMC Advantage Goals Gold Select","52899PA003",,"PAN004","PAS004","PAF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists except OB/GYN or Behavioral Health require a referral.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.998166844996797",,"$500","0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergency Services Only","No","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/pay.aspx","http://www.upmchealthplan.com/marketplace/details.aspx?plan=IND_HMO_Goals_Gold_Serv2_Net4","http://www.upmchealthplan.com/marketplace/rxlist.aspx","52899PA0030041-01","Standard Gold On Exchange Plan","81.20%","0.793956995010376","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,500","$10","$600","$200","$4,100","$800","$0","$80","13"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110001","Healthy Benefits Value HMO 500.0","53789PA011",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml3",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","8"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110001","Healthy Benefits Value HMO 500.0","53789PA011",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml3",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110001-03","Limited Cost Sharing Plan Variation","79.50%","0.795036554336548","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","9"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-01","Standard Silver On Exchange Plan","71.25%","0.71254825592041","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","10"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","11"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-03","Limited Cost Sharing Plan Variation","71.25%","0.71254825592041","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","12"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-04","73% AV Level Silver Plan","73.90%","0.739008069038391","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$900","0%","$450","$900","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$20","$700","$0","$200","$500","$2,200","$0","$80","13"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-05","87% AV Level Silver Plan","87.93%","0.879281103610992","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","0%","$200","$400","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$20","$200","$0","$200","$200","$1,200","$0","$80","14"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100002","Healthy Benefits HMO 0.0","53789PA010",,"PAN002","PAS002","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml4",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100002-06","94% AV Level Silver Plan","93.60%","0.936010897159576","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","15"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-01","Standard Silver On Exchange Plan","71.25%","0.71254825592041","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","16"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","17"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-03","Limited Cost Sharing Plan Variation","71.25%","0.71254825592041","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$0","$200","$0","$400","$0","$80","18"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110002","Healthy Benefits Value HMO 0.0","53789PA011",,"PAN001","PAS001","PAF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000201_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml5",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110002-04","73% AV Level Silver Plan","73.90%","0.739008069038391","No","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$900","0%","$450","$900","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$20","$700","$0","$200","$500","$2,200","$0","$80","19"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-05","87% AV Level Silver Plan","86.98%","0.869839251041412","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%","$0","$0","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$100","$0","$80","40"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110005","Healthy Benefits Value HMO 0.50","53789PA011",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000501_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml11",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110005-06","94% AV Level Silver Plan","94.14%","0.941377282142639","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","8%","$0","$0","8%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$40","$0","$80","41"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-01","Standard Silver On Exchange Plan","69.35%","0.693517744541168","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","0%","$2,500","$5,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$0","$200","$2,800","$800","$0","$80","42"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","43"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-03","Limited Cost Sharing Plan Variation","69.35%","0.693517744541168","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","0%","$2,500","$5,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$0","$200","$2,800","$800","$0","$80","44"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-04","73% AV Level Silver Plan","73.43%","0.734262228012085","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%","$2,000","$4,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,300","$900","$0","$80","45"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-05","87% AV Level Silver Plan","87.34%","0.873436212539673","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$900","$0","$80","46"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100006","Healthy Benefits HMO 2500.0","53789PA010",,"PAN002","PAS002","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100006-06","94% AV Level Silver Plan","94.43%","0.944288015365601","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","0%","$200","$400","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$0","$0","$200","$400","$600","$0","$80","47"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-01","Standard Silver On Exchange Plan","69.35%","0.693517744541168","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","0%","$2,500","$5,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$0","$200","$2,800","$800","$0","$80","48"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","49"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-03","Limited Cost Sharing Plan Variation","69.35%","0.693517744541168","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","0%","$2,500","$5,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$0","$200","$2,800","$800","$0","$80","50"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-04","73% AV Level Silver Plan","73.43%","0.734262228012085","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%","$2,000","$4,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$0","$200","$2,300","$900","$0","$80","51"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-05","87% AV Level Silver Plan","87.34%","0.873436212539673","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$900","$0","$80","52"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110006","Healthy Benefits Value HMO 2500.0","53789PA011",,"PAN001","PAS001","PAF004","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000601_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml13",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110006-06","94% AV Level Silver Plan","94.43%","0.944288015365601","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","0%","$200","$400","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$0","$0","$200","$400","$600","$0","$80","53"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100007","Healthy Benefits HMO 6000.0","53789PA010",,"PAN002","PAS002","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml14",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100007-01","Standard Bronze On Exchange Plan","60.40%","0.679181218147278","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$4,300","$200","$0","$80","54"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100007","Healthy Benefits HMO 6000.0","53789PA010",,"PAN002","PAS002","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml14",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","55"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0100007","Healthy Benefits HMO 6000.0","53789PA010",,"PAN002","PAS002","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA010000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml14",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0100007-03","Limited Cost Sharing Plan Variation","60.40%","0.679181218147278","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$4,300","$200","$0","$80","56"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110007","Healthy Benefits Value HMO 6000.0","53789PA011",,"PAN001","PAS001","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml15",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110007-01","Standard Bronze On Exchange Plan","60.40%","0.679181218147278","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$4,300","$200","$0","$80","57"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110007","Healthy Benefits Value HMO 6000.0","53789PA011",,"PAN001","PAS001","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml15",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$200","58"
"2014","PA","53789","HIOS","10","2014-01-29 08:00:05","1","53789","PA","Individual","No","23-2399845","53789PA0110007","Healthy Benefits Value HMO 6000.0","53789PA011",,"PAN001","PAS001","PAF005","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA011000701_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml15",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0110007-03","Limited Cost Sharing Plan Variation","60.40%","0.679181218147278","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$200","$4,300","$200","$0","$80","59"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0170001","myBlue Accesss LP $4,500","55957PA017",,"PAN002","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700063000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0170001-00","Standard Bronze Off Exchange Plan","61.70%","0.594795882701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$4,500","$0","$560","$150","$2,170","$0","$0","$105","8"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0170001","myBlue Accesss LP $4,500","55957PA017",,"PAN002","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700063000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0170001-01","Standard Bronze On Exchange Plan","61.70%","0.594795882701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$4,500","$0","$560","$150","$2,170","$0","$0","$105","9"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0170001","myBlue Accesss LP $4,500","55957PA017",,"PAN002","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700063000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","1","55957","PA","Individual","No","23-2905083","55957PA0170001","myBlue Accesss LP $4,500","55957PA017",,"PAN002","PAS001","PAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700063000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0170001-03","Limited Cost Sharing Plan Variation","61.70%","0.594795882701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$4,500","$0","$560","$150","$2,170","$0","$0","$105","11"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-00","Standard Silver Off Exchange Plan","70.40%","0.704418182373047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$960","$150","$1,440","$200","$0","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-01","Standard Silver On Exchange Plan","70.40%","0.704418182373047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$960","$150","$1,440","$200","$0","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-03","Limited Cost Sharing Plan Variation","70.40%","0.704418182373047","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$960","$150","$1,440","$200","$0","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-04","73% AV Level Silver Plan","73.00%","0.729937434196472","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-05","87% AV Level Silver Plan","86.20%","0.861655473709106","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","2","55957","PA","Individual","No","23-2905083","55957PA0180001","myBlue Choice $2,500","55957PA018",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700064000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180001-06","94% AV Level Silver Plan","93.30%","0.927033305168152","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$100","$200","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-00","Standard Silver Off Exchange Plan","69.80%","0.698279321193695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$1,450","$150","$1,440","$280","$0","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-01","Standard Silver On Exchange Plan","69.80%","0.698279321193695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$1,450","$150","$1,440","$280","$0","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-03","Limited Cost Sharing Plan Variation","69.80%","0.698279321193695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$1,450","$150","$1,440","$280","$0","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-04","73% AV Level Silver Plan","73.50%","0.725658774375916","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-05","87% AV Level Silver Plan","87.20%","0.86859518289566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","3","55957","PA","Individual","No","23-2905083","55957PA0190001","myBlue Access $1,500","55957PA019",,"PAN002","PAS001","PAF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"1","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700065000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190001-06","94% AV Level Silver Plan","93.30%","0.93144679069519","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$350","$700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$100","$200","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","6","55957","PA","Individual","No","23-2905083","55957PA0260001","myBlueCare","55957PA026",,"PAN002","PAS001","PAF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700066000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0260001-06","94% AV Level Silver Plan","93.80%","0.937662422657013","No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$200","$400","$450","$900","$10,000","$20,000","Not Applicable","Not Applicable","$100","$200","10%","$200","$400","30%","$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","100%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","7","55957","PA","Individual","No","23-2905083","55957PA0180003","myBlue Choice $250","55957PA018",,"PAN001","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180003-00","Standard Platinum Off Exchange Plan","89.80%","0.897513747215271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$0","$705","$150","$250","$0","$192","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","7","55957","PA","Individual","No","23-2905083","55957PA0180003","myBlue Choice $250","55957PA018",,"PAN001","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180003-01","Standard Platinum On Exchange Plan","89.80%","0.897513747215271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$0","$705","$150","$250","$0","$192","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","7","55957","PA","Individual","No","23-2905083","55957PA0180003","myBlue Choice $250","55957PA018",,"PAN001","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","7","55957","PA","Individual","No","23-2905083","55957PA0180003","myBlue Choice $250","55957PA018",,"PAN001","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700071000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0180003-03","Limited Cost Sharing Plan Variation","89.80%","0.897513747215271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$0","$705","$150","$250","$0","$192","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","8","55957","PA","Individual","No","23-2905083","55957PA0190003","myBlue Access $500","55957PA019",,"PAN002","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190003-00","Standard Platinum Off Exchange Plan","88.40%","0.900578856468201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$0","$150","$500","$0","$0","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","8","55957","PA","Individual","No","23-2905083","55957PA0190003","myBlue Access $500","55957PA019",,"PAN002","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190003-01","Standard Platinum On Exchange Plan","88.40%","0.900578856468201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$0","$150","$500","$0","$0","$105","5"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","8","55957","PA","Individual","No","23-2905083","55957PA0190003","myBlue Access $500","55957PA019",,"PAN002","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","8","55957","PA","Individual","No","23-2905083","55957PA0190003","myBlue Access $500","55957PA019",,"PAN002","PAS001","PAF007","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700072000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190003-03","Limited Cost Sharing Plan Variation","88.40%","0.900578856468201","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$0","$150","$500","$0","$0","$105","7"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","9","55957","PA","Individual","No","23-2905083","55957PA0190004","myBlue Access $6,350","55957PA019",,"PAN002","PAS001","PAF008","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700073000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$2,170","$0","$0","$105","4"
"2014","PA","55957","HIOS","5","2013-11-26 13:14:08","9","55957","PA","Individual","No","23-2905083","55957PA0190004","myBlue Access $6,350","55957PA019",,"PAN002","PAS001","PAF008","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700073000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0190004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$2,170","$0","$0","$105","5"
"2014","PA","59656","HIOS","6","2014-01-21 08:29:49","1","59656","PA","SHOP (Small Group)","Yes","23-2541529","59656PA0020001","Smile for Health Child 0-19 DHMO","59656PA002",,"PAN001","PAS001",,"New","HMO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No",,,,,"59656PA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","59656","HIOS","6","2014-01-21 08:29:49","2","59656","PA","SHOP (Small Group)","Yes","23-2541529","59656PA0010001","Smile for Health Child DHMO","59656PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-dhmo.pdf",,,,"59656PA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012576","Marketplace Direct 5","75729PA001",,"PAN001","PAS001","PAF005","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012576-01","Standard Gold On Exchange Plan","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012597"," Marketplace Direct 5","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012597-01","Standard Gold On Exchange Plan","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","7","64844","PA","Individual","No","23-2169745","64844PA0050007","Aetna Premier 2000 PD","64844PA005",,"PAN001","PAS001","PAF007","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","7","64844","PA","Individual","No","23-2169745","64844PA0050007","Aetna Premier 2000 PD","64844PA005",,"PAN001","PAS001","PAF007","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020001","Gold $5 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73006","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"4"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020001","Gold $5 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73006","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"5"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","1","64844","PA","Individual","No","23-2169745","64844PA0050001","Aetna Advantage 5750 PD","64844PA005",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998592893127211",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","1","64844","PA","Individual","No","23-2169745","64844PA0050001","Aetna Advantage 5750 PD","64844PA005",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998592893127211",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","2","64844","PA","Individual","No","23-2169745","64844PA0050002","Aetna Advantage 6350","64844PA005",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","2","64844","PA","Individual","No","23-2169745","64844PA0050002","Aetna Advantage 6350","64844PA005",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200002","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN003","PAS001","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard in network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0200002-01","Standard Silver On Exchange Plan","68.38%","0.683790028095245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-03","Limited Cost Sharing Plan Variation","69.10%","0.690709412097931","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012584","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012584-01","Standard Silver On Exchange Plan","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012597"," Marketplace Direct 5","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012597-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012594","Marketplace Direct 3","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012594-01","Standard Gold On Exchange Plan","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012594","Marketplace Direct 3","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012594-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-04","73% AV Level Silver Plan","72.30%","0.722597599029541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-05","87% AV Level Silver Plan","87.50%","0.874894440174103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,800","$25,600","Not Applicable","Not Applicable","$650","$1,300","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-06","94% AV Level Silver Plan","94.10%","0.941447615623474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,800","$25,600","Not Applicable","Not Applicable","$100","$200","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170005","Shared Cost Blue PPO 1500","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170005-01","Standard Gold On Exchange Plan","78.40%","0.784273862838745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170005","Shared Cost Blue PPO 1500","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170005","Shared Cost Blue PPO 1500","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170005-03","Limited Cost Sharing Plan Variation","78.40%","0.784273862838745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012607","Marketplace Direct 13","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012607-03","Limited Cost Sharing Plan Variation","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012608","Marketplace Value","75729PA001",,"PAN001","PAS001","PAF001","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceValue.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012608-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012606","Marketplace Direct 12","75729PA001",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012606-01","Standard Bronze On Exchange Plan","60.45%","0.643306612968445","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$1,500","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012606","Marketplace Direct 12","75729PA001",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012606-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","6","82110","PA","Individual","Yes","23-1667011","82110PA0030004","DeltaCare USA Plan 85 for Children + Preferred for Adults","82110PA003",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030004",,"82110PA0030004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","6","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040004",,"82110PA0040004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","6","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040004",,"82110PA0040004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","6","82110","PA","Individual","Yes","23-1667011","82110PA0030004","DeltaCare USA Plan 85 for Children + Preferred for Adults","82110PA003",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030004",,"82110PA0030004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","SHOP (Small Group)","No","23-2195219","82795PA0060002","Healthy Benefits PPO 1000.0 EX","82795PA006",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/sg/82795PA006000200_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0060002-01","Standard Gold On Exchange Plan","81.73%","0.810751616954803","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%","$100","$200","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$200","$600","$2,100","$0","$80","4"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080001","Healthy Benefits PPO 1000.0","82795PA008",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080001-01","Standard Gold On Exchange Plan","81.73%","0.817280769348145","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%","$100","$200","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$200","$600","$2,100","$0","$80","4"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080001","Healthy Benefits PPO 1000.0","82795PA008",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-05","87% AV Level Silver Plan","87.80%","0.879838109016418","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-06","94% AV Level Silver Plan","94.00%","0.940365195274353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-03","Limited Cost Sharing Plan Variation","69.10%","0.691457331180573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-04","73% AV Level Silver Plan","72.30%","0.722597599029541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,800","$25,600","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"26"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-03","Limited Cost Sharing Plan Variation","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","1","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0170001","EHB Basic Dental Plan (Low)","98060PA017",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$17.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48055",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48054",,"98060PA0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","1","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0170001","EHB Basic Dental Plan (Low)","98060PA017",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$17.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48055",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48054",,"98060PA0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","2","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0180001","EHB Enhanced Dental Plan (High)","98060PA018",,"PAN002","PAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$22.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49120",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49119",,"98060PA0180001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-06","94% AV Level Silver Plan","93.70%","0.936530709266663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1300","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180005-01","Standard Gold On Exchange Plan","80.70%","0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","7","64844","PA","Individual","No","23-2169745","64844PA0050007","Aetna Premier 2000 PD","64844PA005",,"PAN001","PAS001","PAF007","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","8","64844","PA","Individual","No","23-2169745","64844PA0050005","Aetna Basic","64844PA005",,"PAN001","PAS001","PAF005","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-03","Limited Cost Sharing Plan Variation","69.10%","0.690709412097931","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-04","73% AV Level Silver Plan","73.40%","0.733907520771027","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-05","87% AV Level Silver Plan","87.80%","0.879838109016418","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-06","94% AV Level Silver Plan","94.00%","0.940365195274353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Blue PPO 3400","70194PA015",,"PAN001","PAS003","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150001-01","Standard Bronze On Exchange Plan","61.90%","0.618958473205566","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","30%",,,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210001","FLEX EPO $500/$1000 A Community Blue Plan","70194PA021",,"PAN003","PAS004","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In Network Only","Yes","BlueCard In Network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0210001-01","Standard Gold On Exchange Plan","81.98%","0.819923579692841","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210003","FLEX EPO $500/$1000 A Community Blue Plan","70194PA021",,"PAN003","PAS005","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In Network Only","Yes","BlueCard In Network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0210003-01","Standard Gold On Exchange Plan","81.98%","0.819923579692841","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$2,200","$4,400","$4,150","$8,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Blue PPO 3400","70194PA015",,"PAN001","PAS003","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-05","87% AV Level Silver Plan","88.00%","0.871913731098175","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-06","94% AV Level Silver Plan","94.72%","0.944616556167603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020004","Bronze Deductible Only HMO HSA Eligible","91303PA002",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73003","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0",,,"$6,300","$0",,,"16"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020004","Bronze Deductible Only HMO HSA Eligible","91303PA002",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73003","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"$0","$0",,,"17"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 5500","70194PA014",,"PAN001","PAS003","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140001-01","Standard Bronze On Exchange Plan","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 5500","70194PA014",,"PAN001","PAS003","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","67499","HIOS","5","2014-01-16 07:24:04","1","67499","PA","Individual","Yes","39-1263473","67499PA0010001","Humana Dental Smart Choice","67499PA001",,"PAN001","PAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084316",,"67499PA0010001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200001","Comprehensive Care EPO $1500 70% A Community Blue Plan","70194PA020",,"PAN003","PAS001","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard in network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0200001-01","Standard Gold On Exchange Plan","78.23%","0.782333493232727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-01","Standard Silver On Exchange Plan","69.10%","0.690709412097931","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200003","Comprehensive Care EPO $1500 70% A Community Blue Plan","70194PA020",,"PAN003","PAS002","PAF006","New","EPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard in network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0200003-01","Standard Gold On Exchange Plan","78.23%","0.782333493232727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","59656","HIOS","6","2014-01-21 08:29:49","2","59656","PA","SHOP (Small Group)","Yes","23-2541529","59656PA0010001","Smile for Health Child DHMO","59656PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-pa-grp-child-dhmo.pdf",,,,"59656PA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","59656","HIOS","6","2014-01-21 08:29:49","2","59656","PA","SHOP (Small Group)","Yes","23-2541529","59656PA0010002","Smile for Health Family DHMO","59656PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-dhmo.pdf",,,,"59656PA0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","59656","HIOS","6","2014-01-21 08:29:49","2","59656","PA","SHOP (Small Group)","Yes","23-2541529","59656PA0010002","Smile for Health Family DHMO","59656PA001",,"PAN001","PAS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-pa-grp-family-dhmo.pdf",,,,"59656PA0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","1","64844","PA","Individual","No","23-2169745","64844PA0050001","Aetna Advantage 5750 PD","64844PA005",,"PAN001","PAS001","PAF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998592893127211",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","2","64844","PA","Individual","No","23-2169745","64844PA0050002","Aetna Advantage 6350","64844PA005",,"PAN001","PAS001","PAF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","4","64844","PA","Individual","No","23-2169745","64844PA0050004","Aetna AdvantagePlus 5500 PD","64844PA005",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","4","64844","PA","Individual","No","23-2169745","64844PA0050004","Aetna AdvantagePlus 5500 PD","64844PA005",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","4","64844","PA","Individual","No","23-2169745","64844PA0050004","Aetna AdvantagePlus 5500 PD","64844PA005",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","64844","HIOS","6","2013-09-17 16:07:07","5","64844","PA","Individual","No","23-2169745","64844PA0050008","Aetna Classic 5000","64844PA005",,"PAN001","PAS001","PAF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998591094685921",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/pa.html","64844PA0050008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-03","Limited Cost Sharing Plan Variation","69.10%","0.691457331180573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-05","87% AV Level Silver Plan","87.50%","0.874894440174103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,800","$25,600","Not Applicable","Not Applicable","$650","$1,300","10%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-06","94% AV Level Silver Plan","94.10%","0.941447615623474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,800","$25,600","Not Applicable","Not Applicable","$100","$200","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160003-01","Standard Platinum On Exchange Plan","88.00%","0.8981654047966","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012594","Marketplace Direct 3","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012594-03","Limited Cost Sharing Plan Variation","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-01","Standard Silver On Exchange Plan","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0200004","Comprehensive Care EPO $2000 70% A Community Blue Plan","70194PA020",,"PAN003","PAS002","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In network only","Yes","BlueCard in network only","Yes","https://www.highmarkbcbs.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0200004-01","Standard Silver On Exchange Plan","68.38%","0.683790028095245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0160001","Comprehensive Care Blue PPO 1500","70194PA016",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160001-04","73% AV Level Silver Plan","73.40%","0.733907520771027","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-01","Standard Silver On Exchange Plan","69.10%","0.691457331180573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0170003","Shared Cost Blue PPO 3200","70194PA017",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012607","Marketplace Direct 13","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012607-01","Standard Bronze On Exchange Plan","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012607","Marketplace Direct 13","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012607-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-01","Standard Silver On Exchange Plan","69.10%","0.690709412097931","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","1","70194","PA","Individual","No","54-1637426","70194PA0190001","Comprehensive Care Blue PPO 1500","70194PA019",,"PAN002","PAS006","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210002","FLEX EPO $1650 A Community Blue Plan","70194PA021",,"PAN003","PAS004","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In Network Only","Yes","BlueCard In Network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0210002-01","Standard Silver On Exchange Plan","69.02%","0.690577149391174","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","20%","$1,650","$3,300","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150001","Health Savings Blue PPO 3400","70194PA015",,"PAN001","PAS003","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150001-03","Limited Cost Sharing Plan Variation","61.90%","0.618958473205566","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","30%",,,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","SHOP (Small Group)","No","54-1637426","70194PA0210004","FLEX EPO $1650 A Community Blue Plan","70194PA021",,"PAN003","PAS005","PAF006","New","EPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide In Network Only","Yes","BlueCard In Network only","Yes","https://www.highmarkblueshield.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/",,"70194PA0210004-01","Standard Silver On Exchange Plan","69.02%","0.690577149391174","Yes","Yes","Yes","85%","15%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","20%","$1,650","$3,300","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-01","Standard Silver On Exchange Plan","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-03","Limited Cost Sharing Plan Variation","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-04","73% AV Level Silver Plan","74.00%","0.73978066444397","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-05","87% AV Level Silver Plan","87.50%","0.874623596668243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150003","Health Savings Blue PPO 2500","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150003-06","94% AV Level Silver Plan","93.70%","0.936530709266663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1300","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150005-01","Standard Gold On Exchange Plan","80.70%","0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1300","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0150005","Health Savings Blue PPO 1300","70194PA015",,"PAN001","PAS003","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0150005-03","Limited Cost Sharing Plan Variation","80.70%","0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Blue PPO 3400","70194PA018",,"PAN002","PAS006","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180001-01","Standard Bronze On Exchange Plan","61.90%","0.618958473205566","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","30%",,,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Blue PPO 3400","70194PA018",,"PAN002","PAS006","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-01","Standard Silver On Exchange Plan","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012585"," Marketplace Direct 12","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012585-01","Standard Bronze On Exchange Plan","60.45%","0.643306612968445","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012586","Marketplace Direct 13","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect13.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012586-01","Standard Bronze On Exchange Plan","58.52%","0.615515053272247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012582","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012582-01","Standard Silver On Exchange Plan","69.36%","0.698679864406586","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020001",,"82110PA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","Individual","Yes","23-1667011","82110PA0010001","Delta Dental PPO Plan 70 for Children","82110PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010001",,"82110PA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","Individual","Yes","23-1667011","82110PA0010001","Delta Dental PPO Plan 70 for Children","82110PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010001",,"82110PA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020001",,"82110PA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","Individual","Yes","23-1667011","82110PA0010002","Delta Dental PPO Plan 85 for Children","82110PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010002",,"82110PA0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.83",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020002",,"82110PA0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.83",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020002",,"82110PA0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","1","82110","PA","Individual","Yes","23-1667011","82110PA0010002","Delta Dental PPO Plan 85 for Children","82110PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010002",,"82110PA0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","2","82110","PA","Individual","Yes","23-1667011","82110PA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","82110PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010006",,"82110PA0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","2","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020006",,"82110PA0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","2","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.07",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020006",,"82110PA0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","2","82110","PA","Individual","Yes","23-1667011","82110PA0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","82110PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.96",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010006",,"82110PA0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","3","82110","PA","Individual","Yes","23-1667011","82110PA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","82110PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010004",,"82110PA0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180001","Health Savings Blue PPO 3400","70194PA018",,"PAN002","PAS006","PAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9977",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180001-03","Limited Cost Sharing Plan Variation","61.90%","0.618958473205566","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","30%",,,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-01","Standard Silver On Exchange Plan","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-03","Limited Cost Sharing Plan Variation","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-04","73% AV Level Silver Plan","74.00%","0.73978066444397","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180003","Health Savings Blue PPO 2500","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180003-05","87% AV Level Silver Plan","87.50%","0.874623596668243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1300","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","2","70194","PA","Individual","No","54-1637426","70194PA0180005","Health Savings Blue PPO 1300","70194PA018",,"PAN002","PAS006","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9985",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0180005-03","Limited Cost Sharing Plan Variation","80.70%","0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140005","Shared Cost Blue PPO 1500","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140005-01","Standard Gold On Exchange Plan","78.40%","0.784273862838745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140005","Shared Cost Blue PPO 1500","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140005","Shared Cost Blue PPO 1500","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140005-03","Limited Cost Sharing Plan Variation","78.40%","0.784273862838745","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","3","70194","PA","Individual","No","54-1637426","70194PA0140003","Shared Cost Blue PPO 3200","70194PA014",,"PAN001","PAS003","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,"$200","0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140003-01","Standard Silver On Exchange Plan","69.10%","0.691457331180573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0160003","Comprehensive Care Blue PPO 500","70194PA016",,"PAN001","PAS003","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0160003-03","Limited Cost Sharing Plan Variation","88.00%","0.8981654047966","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0190003","Comprehensive Care Blue PPO 500","70194PA019",,"PAN002","PAS006","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190003-01","Standard Platinum On Exchange Plan","88.00%","0.8981654047966","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0190003","Comprehensive Care Blue PPO 500","70194PA019",,"PAN002","PAS006","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","4","70194","PA","Individual","No","54-1637426","70194PA0190003","Comprehensive Care Blue PPO 500","70194PA019",,"PAN002","PAS006","PAF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0190003-03","Limited Cost Sharing Plan Variation","88.00%","0.8981654047966","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,650","$3,300",,,"$3,300","$6,600","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-01","Standard Silver On Exchange Plan","71.55%","0.721780359745026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-03","Limited Cost Sharing Plan Variation","71.55%","0.721780359745026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012599"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012599-04","73% AV Level Silver Plan","73.76%","0.745163321495056","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0140001","Shared Cost Blue PPO 5500","70194PA014",,"PAN001","PAS003","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkbcbs.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0140001-03","Limited Cost Sharing Plan Variation","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 5500","70194PA017",,"PAN002","PAS006","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170001-01","Standard Bronze On Exchange Plan","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 5500","70194PA017",,"PAN002","PAS006","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","PA","70194","HIOS","8","2014-03-19 07:06:49","5","70194","PA","Individual","No","54-1637426","70194PA0170001","Shared Cost Blue PPO 5500","70194PA017",,"PAN002","PAS006","PAF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9978",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmarkblueshield.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/",,"70194PA0170001-03","Limited Cost Sharing Plan Variation","61.40%","0.61387699842453","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","70533","HIOS","3","2013-07-31 07:05:07","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010001","DentalConnect�","70533PA001",,"PAN001","PAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.48",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"70533PA0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70533","HIOS","3","2013-07-31 07:05:07","1","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010002","DentalConnect�","70533PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"70533PA0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","70533","HIOS","3","2013-07-31 07:05:07","2","70533","PA","SHOP (Small Group)","Yes","35-0472300","70533PA0010003","DentalConnect�","70533PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"70533PA0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010001","BEST Life Child Dental Plus","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Child_Dental_Plus_Plan.pdf",,"71933PA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","Individual","Yes","95-6042390","71933PA0020001","BESTOne Child Dental Plus","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Child_Dental_Plus_Plan.pdf",,"71933PA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","Individual","Yes","95-6042390","71933PA0020001","BESTOne Child Dental Plus","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Child_Dental_Plus_Plan.pdf",,"71933PA0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010001","BEST Life Child Dental Plus","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Child_Dental_Plus_Plan.pdf",,"71933PA0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010002","BEST Life Child Dental","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Child_Dental_Plan.pdf",,"71933PA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010002","BEST Life Child Dental","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Child_Dental_Plan.pdf",,"71933PA0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010003","BEST Dental Advantage - Gold","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"71933PA0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010003","BEST Dental Advantage - Gold","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"71933PA0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010004","BEST Dental Plus - Gold","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Plus_Plan_(Gold).pdf",,"71933PA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010004","BEST Dental Plus - Gold","71933PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Plus_Plan_(Gold).pdf",,"71933PA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010005","BEST Dental Plus - Silver","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Plus_Plan_(Silver).pdf",,"71933PA0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010005","BEST Dental Plus - Silver","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Plus_Plan_(Silver).pdf",,"71933PA0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010006","BEST Dental Basic - Silver","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Basic_Plan_(Silver).pdf",,"71933PA0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","1","71933","PA","SHOP (Small Group)","Yes","95-6042390","71933PA0010006","BEST Dental Basic - Silver","71933PA001",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BEST_Dental_Basic_Plan_(Silver).pdf",,"71933PA0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","2","71933","PA","Individual","Yes","95-6042390","71933PA0020002","BESTOne Child Dental","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Child_Dental_Plan.pdf",,"71933PA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","2","71933","PA","Individual","Yes","95-6042390","71933PA0020002","BESTOne Child Dental","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Child_Dental_Plan.pdf",,"71933PA0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","3","71933","PA","Individual","Yes","95-6042390","71933PA0020003","BESTOne Dental Advantage - Gold","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"71933PA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","3","71933","PA","Individual","Yes","95-6042390","71933PA0020003","BESTOne Dental Advantage - Gold","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"71933PA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","3","71933","PA","Individual","Yes","95-6042390","71933PA0020004","BESTOne Dental Plus - Gold","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"71933PA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","3","71933","PA","Individual","Yes","95-6042390","71933PA0020004","BESTOne Dental Plus - Gold","71933PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"71933PA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","4","71933","PA","Individual","Yes","95-6042390","71933PA0020005","BESTOne Dental Plus - Silver","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"71933PA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","4","71933","PA","Individual","Yes","95-6042390","71933PA0020005","BESTOne Dental Plus - Silver","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"71933PA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","4","71933","PA","Individual","Yes","95-6042390","71933PA0020006","BESTOne Dental Basic - Silver","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"71933PA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","71933","HIOS","8","2014-01-21 08:29:49","4","71933","PA","Individual","Yes","95-6042390","71933PA0020006","BESTOne Dental Basic - Silver","71933PA002",,"PAN001","PAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/PA/pdf/PA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"71933PA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012597"," Marketplace Direct 5","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect5.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012597-03","Limited Cost Sharing Plan Variation","78.34%","0.784813046455383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012583","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012583-01","Standard Silver On Exchange Plan","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-03","Limited Cost Sharing Plan Variation","68.27%","0.719648420810699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-04","73% AV Level Silver Plan","72.37%","0.766054570674896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,375","$2,750","15%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-05","87% AV Level Silver Plan","87.46%","0.889027893543243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012605","Marketplace Direct 11","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect11.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012605-06","94% AV Level Silver Plan","94.94%","0.936664581298828","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-01","Standard Silver On Exchange Plan","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-03","Limited Cost Sharing Plan Variation","68.11%","0.70848149061203","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-04","73% AV Level Silver Plan","72.75%","0.755517482757568","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-05","87% AV Level Silver Plan","87.46%","0.874518513679504","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012604","Marketplace Direct 10","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect10.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012604-06","94% AV Level Silver Plan","94.94%","0.93335235118866","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","1","75729","PA","Individual","No","20-4275139","75729PA0012606","Marketplace Direct 12","75729PA001",,"PAN001","PAS001","PAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect12.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012606-03","Limited Cost Sharing Plan Variation","60.45%","0.643306612968445","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$1,500","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012588","Marketplace HRA1","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$2,000.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012588-01","Standard Silver On Exchange Plan","70.27%","0.821345806121826","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012592","Marketplace Direct 1","75729PA001",,"PAN001","PAS001","PAF009","New","PPO","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012592-01","Standard Platinum On Exchange Plan","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012589","Marketplace HRA2","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$2,500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012589-01","Standard Silver On Exchange Plan","70.55%","0.819191098213196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"8"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"9"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"10"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$10",,,"11"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$250",,,"$0","$25","$200",,"12"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020003","Bronze $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73000","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,600","$500",,,"$5,600","$10",,,"13"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020003","Bronze $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73000","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"$0","$0",,,"14"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020003","Bronze $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73000","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,600","$500",,,"$5,600","$10",,,"15"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020004","Bronze Deductible Only HMO HSA Eligible","91303PA002",,"PAN001","PAS001","PAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73003","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0",,,"$6,300","$0",,,"18"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","2","91303","PA","Individual","No","25-1264318","91303PA0020005","Catastrophic 100% HMO Plan","91303PA002",,"PAN001","PAS001","PAF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73004","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0",,,"$6,350","$0",,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020036","Gold $0 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72215","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020036-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020036","Gold $0 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72215","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020036-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,750","$11,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$1,750","$3,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012592","Marketplace Direct 1","75729PA001",,"PAN001","PAS001","PAF009","New","PPO","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012592-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012590","Marketplace HRA3","75729PA001",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","Yes","$1,500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceHRA3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureGroup.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012590-01","Standard Silver On Exchange Plan","70.65%","0.801608145236969","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012592","Marketplace Direct 1","75729PA001",,"PAN001","PAS001","PAF009","New","PPO","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012592-03","Limited Cost Sharing Plan Variation","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012596","Marketplace Direct 4","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012596-01","Standard Gold On Exchange Plan","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$250","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012596","Marketplace Direct 4","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012596-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012596","Marketplace Direct 4","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012596-03","Limited Cost Sharing Plan Variation","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$250","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-05","87% AV Level Silver Plan","86.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020038","Silver $10 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72244","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020038-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020033","Gold $0 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72243","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020033-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020034","Gold $0 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72257","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020034-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-01","Standard Silver On Exchange Plan","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-03","Limited Cost Sharing Plan Variation","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-04","73% AV Level Silver Plan","73.75%","0.746763467788696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-05","87% AV Level Silver Plan","88.00%","0.871913731098175","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012602","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012602-06","94% AV Level Silver Plan","94.72%","0.944616556167603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-04","73% AV Level Silver Plan","73.75%","0.746763467788696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-05","87% AV Level Silver Plan","88.00%","0.871913731098175","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$175","$350","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","6","75729","PA","Individual","No","20-4275139","75729PA0012603","Marketplace Direct 9","75729PA001",,"PAN001","PAS001","PAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect9.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST","http://www.thehealthplan.com/Reform/Marketplace/Documents/AllPlansBrochureIndividual.pdf","http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012603-06","94% AV Level Silver Plan","94.72%","0.944616556167603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$15,000","$30,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012571","Marketplace Direct 1","75729PA001",,"PAN001","PAS001","PAF009","New","PPO","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect1.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012571-01","Standard Platinum On Exchange Plan","89.34%","0.890281915664673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012575","Marketplace Direct 4","75729PA001",,"PAN001","PAS001","PAF006","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect4.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012575-01","Standard Gold On Exchange Plan","80.35%","0.799538254737854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$125","$125","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012578"," Marketplace Direct 6","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect6.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012578-01","Standard Silver On Exchange Plan","71.55%","0.721780359745026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012579","Marketplace Direct 7","75729PA001",,"PAN001","PAS001","PAF007","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect7.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012579-01","Standard Silver On Exchange Plan","71.42%","0.721022725105286","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012581","Marketplace Direct 8","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect8.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012581-01","Standard Silver On Exchange Plan","69.78%","0.703874588012695","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012570"," Marketplace Direct 2","75729PA001",,"PAN001","PAS001","PAF008","New","PPO","Platinum","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect2.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012570-01","Standard Platinum On Exchange Plan","90.88%","0.910953402519226","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","75729","HIOS","11","2013-12-20 07:30:10","7","75729","PA","SHOP (Small Group)","No","20-4275139","75729PA0012573"," Marketplace Direct 3","75729PA001",,"PAN001","PAS001","PAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,"Acupuncture, Bariatric Surgery,  Cosmetic Surgery, Hearing Aids, Infertility Treatment, Long-Term/Custodial Nursing Home Care, Non-Emergency Care When Traveling Outside the U.S., Private-Duty Nursing, Routine Foot Care, Weight Loss Programs, Dental Care, Orthodontia",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent and urgent care.","Yes","Emergent and urgent care covered. Other services covered with a referral.","No","http://www.thehealthplan.com/Reform/Marketplace/Documents/SBC/ChoiceMarketplaceDirect3.pdf","https://security.thehealthplan.com/sso/saml20/FFM/IDP/POST",,"http://www.thehealthplan.com/reform/marketplace/formulary/","75729PA0012573-01","Standard Gold On Exchange Plan","81.75%","0.824118256568909","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$300","$600","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","3","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.83",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020004",,"82110PA0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","3","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","82110PA002",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.83",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/pa/82110pa0020004",,"82110PA0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","3","82110","PA","Individual","Yes","23-1667011","82110PA0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","82110PA001",,"PAN001","PAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0010004",,"82110PA0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","Individual","Yes","23-1667011","82110PA0030001","DeltaCare USA Plan 70 for Children","82110PA003",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030001",,"82110PA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040001","DeltaCare USA Plan 70 for Children for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040001",,"82110PA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","Individual","Yes","23-1667011","82110PA0030001","DeltaCare USA Plan 70 for Children","82110PA003",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030001",,"82110PA0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040001","DeltaCare USA Plan 70 for Children for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040001",,"82110PA0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","Individual","Yes","23-1667011","82110PA0030002","DeltaCare USA Plan 85 for Children","82110PA003",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030002",,"82110PA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040002","DeltaCare USA Plan 85 for Children for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040002",,"82110PA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040002","DeltaCare USA Plan 85 for Children for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040002",,"82110PA0040002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","4","82110","PA","Individual","Yes","23-1667011","82110PA0030002","DeltaCare USA Plan 85 for Children","82110PA003",,"PAN002","PAS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030002",,"82110PA0030002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","5","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040006",,"82110PA0040006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","5","82110","PA","Individual","Yes","23-1667011","82110PA0030006","DeltaCare USA Plan 70 for Children + Basic for Adults","82110PA003",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030006",,"82110PA0030006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","5","82110","PA","SHOP (Small Group)","Yes","23-1667011","82110PA0040006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","82110PA004",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/pa/82110pa0040006",,"82110PA0040006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82110","HIOS","7","2014-01-21 08:29:49","5","82110","PA","Individual","Yes","23-1667011","82110PA0030006","DeltaCare USA Plan 70 for Children + Basic for Adults","82110PA003",,"PAN002","PAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/pa/82110pa0030006",,"82110PA0030006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080001","Healthy Benefits PPO 1000.0","82795PA008",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080001-03","Limited Cost Sharing Plan Variation","81.73%","0.817280769348145","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%","$100","$200","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$200","$600","$2,100","$0","$80","6"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-01","Standard Silver On Exchange Plan","69.92%","0.699203729629517","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,000","$12,000","0%","$6,000","$12,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$300","$600","0%","$300","$600","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$0","$200","$700","$2,300","$0","$80","7"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$80","8"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-03","Limited Cost Sharing Plan Variation","69.92%","0.699203729629517","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,000","$12,000","0%","$6,000","$12,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$300","$600","0%","$300","$600","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$0","$200","$700","$2,300","$0","$80","9"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-04","73% AV Level Silver Plan","72.30%","0.771142423152924","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","$4,750","$9,500","0%","$4,750","$9,500","0%","$4,500","$9,500","Not Applicable","Not Applicable","$275","$550","0%","$275","$550","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,800","$0","$0","$200","$700","$1,300","$0","$80","10"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-05","87% AV Level Silver Plan","86.06%","0.860471725463867","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","$2,000","$4,000","0%","$2,000","$4,000","0%","$4,000","$7,000","Not Applicable","Not Applicable","$150","$300","0%","$150","$300","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$0","$200","$600","$1,400","$0","$80","11"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","1","82795","PA","Individual","No","23-2195219","82795PA0080002","Healthy Benefits PPO 6000.0","82795PA008",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/82795PA008000202_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0080002-06","94% AV Level Silver Plan","93.67%","0.936685025691986","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","$500","$1,000","0%","$250","$500","0%","$250","$500","Not Applicable","Not Applicable","$25","$50","0%","$25","$50","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$0","$200","$500","$200","$0","$80","12"
"2014","PA","82795","HIOS","8","2013-11-26 13:14:08","2","82795","PA","SHOP (Small Group)","No","23-2195219","82795PA0060001","Healthy Benefits PPO 6000.0 EX","82795PA006",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/sg/82795PA006000100_2014.pdf","https://w2.capbluecross.com/sp/ACS.sam12",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","82795PA0060001-01","Standard Silver On Exchange Plan","69.92%","0.700788021087646","No","Yes","Yes","40%","60%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,000","$12,000","0%","$6,000","$12,000","0%","$5,000","$10,000","Not Applicable","Not Applicable","$300","$600","0%","$300","$600","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,000","$0","$0","$200","$700","$2,300","$0","$80","4"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020001","Gold $5 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73006","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"6"
"2014","PA","91303","HIOS","4","2013-09-17 16:07:07","1","91303","PA","Individual","No","25-1264318","91303PA0020002","Silver $10 Copay HMO Plan","91303PA002",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/PA73008","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopa","http://www.c1formularyhix.com","91303PA0020002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"7"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-01","Standard Silver On Exchange Plan","68.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-03","Limited Cost Sharing Plan Variation","68.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","3","41614","SC","Individual","No","20-0229117","41614SC0020037","Silver $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020037-04","73% AV Level Silver Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020034","Gold $0 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72257","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020034-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020034","Gold $0 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72257","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020034-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020035","Gold $0 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72229","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020035-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020035","Gold $0 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72229","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020035-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020035","Gold $0 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72229","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020035-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020036","Gold $0 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72215","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020036-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,750","$11,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$1,750","$3,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020033","Gold $0 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72243","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020033-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","2","41614","SC","Individual","No","20-0229117","41614SC0020033","Gold $0 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF004","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72243","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020033-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-03","Limited Cost Sharing Plan Variation","68.80%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$0","$0","$150","$3,500","$0","$0","$80","24"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-04","73% AV Level Silver Plan","73.20%","0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","$2,750","$5,500",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","$2,750","$5,500","$2,752","$0","$0","$150","$2,750","$0","$0","$80","25"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$1,000","$0","$0","$150","$1,000","$0","$0","$80","26"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380001","MyChoice Advantage Bronze 5001","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380001-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370006","Business Advantage Silver 2000","49532SC037",,"SCN002","SCS001","SCF005","New","PPO","Silver","No","Both","Yes","Yes","A Physician who is not a Primary Care Physician",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCSGLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0370006-01","Standard Silver On Exchange Plan",,"0.685583889484406","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$3,450","30%",,,,"Not Applicable","Not Applicable","$2,000","$3,450","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-01","Standard Silver On Exchange Plan",,"0.686743795871735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$2,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$2,500","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","10","41614","SC","Individual","No","20-0229117","41614SC0020056","Catastrophic 100% HMO Upstate","41614SC002",,"SCN003","SCS003","SCF001","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72214","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020056-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370006","Business Advantage Silver 2000","49532SC037",,"SCN002","SCS001","SCF005","New","PPO","Silver","No","Both","Yes","Yes","A Physician who is not a Primary Care Physician",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCSGLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0370006-00","Standard Silver Off Exchange Plan",,"0.685583889484406","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$3,450","30%",,,,"Not Applicable","Not Applicable","$2,000","$3,450","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-03","Limited Cost Sharing Plan Variation",,"0.682962894439697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$3,000","Not Applicable",,,,,,,,,"11"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-04","73% AV Level Silver Plan",,"0.722316086292267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,300","Not Applicable",,,,,,,,,"12"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-05","87% AV Level Silver Plan",,"0.869179248809814","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"13"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-06","94% AV Level Silver Plan",,"0.931402146816254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"14"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-00","Standard Silver Off Exchange Plan",,"0.709275007247925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-01","Standard Silver On Exchange Plan",,"0.709275007247925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-03","Limited Cost Sharing Plan Variation",,"0.709275007247925","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-04","73% AV Level Silver Plan",,"0.729394316673279","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"8"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-05","87% AV Level Silver Plan",,"0.872182428836823","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"9"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","2","26065","SC","Individual","No","57-0287419","26065SC0380002","BlueEssentials Silver 1","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380002-06","94% AV Level Silver Plan",,"0.933228313922882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","9%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"10"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-00","Standard Silver Off Exchange Plan",,"0.681290745735168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$2,000","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-01","Standard Silver On Exchange Plan",,"0.681290745735168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$2,000","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","7","41614","SC","Individual","No","20-0229117","41614SC0020047","Bronze 100% POS HSA Eligible Plan","41614SC002",,"SCN005","SCS005","SCF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020047-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","7","41614","SC","Individual","No","20-0229117","41614SC0020047","Bronze 100% POS HSA Eligible Plan","41614SC002",,"SCN005","SCS005","SCF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020047-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020048","Bronze 100% HMO HSA Eligible Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72249","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020048-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020048","Bronze 100% HMO HSA Eligible Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72249","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020048-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020048","Bronze 100% HMO HSA Eligible Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72249","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020048-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020049","Bronze 100% HMO HSA Eligible Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72263","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020049-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380001-00","Standard Gold Off Exchange Plan",,"0.780965507030487","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","Not Applicable",,,"Not Applicable","Not Applicable","$4,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,200","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380001-01","Standard Gold On Exchange Plan",,"0.780965507030487","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","Not Applicable",,,"Not Applicable","Not Applicable","$4,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,200","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials Gold 1","26065SC036",,"SCN002","SCS001","SCF007","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/SBC","https://www.southcarolinablues.com/links/shop/pay","http://www.southcarolinablues.com/links/metallic/businessblueessentials_brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0360001-01","Standard Gold On Exchange Plan",,"0.780965507030487","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials Silver 1","26065SC036",,"SCN002","SCS001","SCF008","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/SBC","https://www.southcarolinablues.com/links/shop/pay","http://www.southcarolinablues.com/links/metallic/businessblueessentials_brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0360002-00","Standard Silver Off Exchange Plan",,"0.708838939666748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$11,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$3,550","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","2","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0180001","EHB Enhanced Dental Plan (High)","98060PA018",,"PAN002","PAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$22.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49120",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49119",,"98060PA0180001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","3","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$17.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121",,"98060PA0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","3","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0190001","Family Basic Dental Plan (Low)","98060PA019",,"PAN003","PAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$17.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49122",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49121",,"98060PA0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","6","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0120001","Delta Dental PPO - Basic Pediatric 2","77305SC012","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$22.40",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0120001-00","Standard Low Off Exchange Plan","71.40%",,,,"Yes","31%","69%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","6","77305","SC","Individual","Yes","43-0908349","77305SC0060001","Delta Dental Individual - Preferred Pediatric PPO Plan","77305SC006","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$44.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0060001-00","Standard High Off Exchange Plan","83.30%",,,,"Yes","55%","45%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$0","Not Applicable",,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-01","Standard Silver On Exchange Plan","68.24%","0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-03","Limited Cost Sharing Plan Variation","68.24%","0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"13"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","4","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN004","PAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$22.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123",,"98060PA0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","PA","98060","HIOS","5","2013-10-16 16:52:58","4","98060","PA","SHOP (Small Group)","Yes","13-5581829","98060PA0200001","Family Enhanced Dental Plan (High)","98060PA020",,"PAN004","PAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$22.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49124",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49123",,"98060PA0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360001","Business BlueEssentials Gold 1","26065SC036",,"SCN002","SCS001","SCF007","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,,,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/SBC","https://www.southcarolinablues.com/links/shop/pay","http://www.southcarolinablues.com/links/metallic/businessblueessentials_brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0360001-00","Standard Gold Off Exchange Plan",,"0.780965507030487","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$7,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","SHOP (Small Group)","No","57-0287419","26065SC0360002","Business BlueEssentials Silver 1","26065SC036",,"SCN002","SCS001","SCF008","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/shop/SBC","https://www.southcarolinablues.com/links/shop/pay","http://www.southcarolinablues.com/links/metallic/businessblueessentials_brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0360002-01","Standard Silver On Exchange Plan",,"0.708838939666748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$11,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$3,550","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380001","BlueEssentials Gold 1","26065SC038",,"SCN001","SCS001","SCF001","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380001-03","Limited Cost Sharing Plan Variation",,"0.780965507030487","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","Not Applicable",,,"Not Applicable","Not Applicable","$4,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,200","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-00","Standard Silver Off Exchange Plan",,"0.682962894439697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$3,000","Not Applicable",,,,,,,,,"8"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-01","Standard Silver On Exchange Plan",,"0.682962894439697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$3,000","Not Applicable",,,,,,,,,"9"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","1","26065","SC","Individual","No","57-0287419","26065SC0380004","BlueEssentials Silver 3","26065SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"10"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-03","Limited Cost Sharing Plan Variation",,"0.681290745735168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$2,000","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-04","73% AV Level Silver Plan",,"0.720782101154327","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$1,300","Not Applicable",,,,,,,,,"8"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-05","87% AV Level Silver Plan",,"0.861020088195801","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$200","Not Applicable",,,,,,,,,"9"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","3","26065","SC","Individual","No","57-0287419","26065SC0380003","BlueEssentials Silver 2","26065SC038",,"SCN001","SCS001","SCF003","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380003-06","94% AV Level Silver Plan",,"0.930801510810852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"10"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","4","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials Bronze 2","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380006-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","4","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials Bronze 2","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380006-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","4","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials Bronze 2","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","4","26065","SC","Individual","No","57-0287419","26065SC0380006","BlueEssentials Bronze 2","26065SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380006-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","5","26065","SC","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0390001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","5","26065","SC","Individual","No","57-0287419","26065SC0390001","BlueEssentials Catastrophic 1","26065SC039",,"SCN001","SCS001","SCF006","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0390001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","6","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380005-00","Standard Bronze Off Exchange Plan",,"0.608006596565247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"4"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","6","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380005-01","Standard Bronze On Exchange Plan",,"0.608006596565247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","6","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","26065","HIOS","4","2013-09-02 11:39:25","6","26065","SC","Individual","No","57-0287419","26065SC0380005","BlueEssentials Bronze 1","26065SC038",,"SCN001","SCS001","SCF005","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","http://www.southcarolinablues.com/links/metallic/BlueEssentials_Brochures","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0380005-03","Limited Cost Sharing Plan Variation",,"0.608006596565247","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","40%",,,,"Not Applicable","Not Applicable","$5,000","Not Applicable",,,,,,,,,"7"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","1","41614","SC","Individual","No","20-0229117","41614SC0020032","Gold $5 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020032-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","1","41614","SC","Individual","No","20-0229117","41614SC0020032","Gold $5 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020032-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","1","41614","SC","Individual","No","20-0229117","41614SC0020032","Gold $5 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020032-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","2","77305","SC","Individual","Yes","43-0908349","77305SC0020001","Delta Dental Individual and Family, PPO-Exclusive - Preferred","77305SC002","7497758624","SCN002","SCS001",,"New","EPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$45.76",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/individual/PPO_Preferred","https://www.deltadentalsc.com/individual/PPO_Preferred_Enroll","https://www.deltadentalsc.com/individual/PPO_Preferred",,"77305SC0020001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","2","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0080001","Delta Dental PPO-Exclusive - Preferred Plan","77305SC008","7497758624","SCN002","SCS001",,"New","EPO","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$25.17",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/shop/PPO_Preferred_Plan","https://www.deltadentalsc.com/shop/PPO_Preferred_Plan_Enroll","https://www.deltadentalsc.com/shop/PPO_Preferred_Plan",,"77305SC0080001-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0030001","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0010001","Delta Dental Individual PPO, EHB Certified","97325SC001",,"SCN002","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0030002","Renaissance Group Dental PPO, EHB Certified","97325SC003",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380001","MyChoice Advantage Bronze 5001","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380001-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380001","MyChoice Advantage Bronze 5001","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-05","87% AV Level Silver Plan",,"0.862309575080872","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$250","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,350","$2,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","5","41614","SC","Individual","No","20-0229117","41614SC0020042","Bronze $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020042-01","Standard Bronze On Exchange Plan","61.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","5","41614","SC","Individual","No","20-0229117","41614SC0020042","Bronze $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020042-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","5","41614","SC","Individual","No","20-0229117","41614SC0020042","Bronze $10 Copay POS Plan","41614SC002",,"SCN005","SCS005","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020042-03","Limited Cost Sharing Plan Variation","61.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020043","Bronze $15 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72248","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020043-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020043","Bronze $15 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72248","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020043-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020043","Bronze $15 Copay POS Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72248","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020043-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020044","Bronze $15 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72262","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020044-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020051","Bronze 100% HMO HSA Eligible Upstate","41614SC002",,"SCN003","SCS003","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72221","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020051-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020039","Silver $10 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF003","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72258","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020039-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-01","Standard Silver On Exchange Plan","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-06","94% AV Level Silver Plan",,"0.932368457317352","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","Not Applicable",,,"Not Applicable","Not Applicable","$750","Not Applicable","$100","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$100","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","4","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0100001","Delta Dental Premier - Preferred Plan","77305SC010","7497758624","SCN001","SCS001",,"New","Indemnity","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$33.53",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/shop/Premier_Preferred_Plan","https://www.deltadentalsc.com/shop/Premier_Preferred_Plan_Enroll","https://www.deltadentalsc.com/shop/Premier_Preferred_Plan",,"77305SC0100001-01","Standard High On Exchange Plan","85.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","4","77305","SC","Individual","Yes","43-0908349","77305SC0040001","Delta Dental Individual and Family, Premier - Preferred","77305SC004","7497758624","SCN001","SCS001",,"New","Indemnity","High",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$60.20",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/individual/Premier_Preferred","https://www.deltadentalsc.com/individual/Premier_Preferred_Enroll","https://www.deltadentalsc.com/individual/Premier_Preferred",,"77305SC0040001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","5","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0110001","Delta Dental PPO - Basic Pediatric 1","77305SC011","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$22.59",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0110001-00","Standard Low Off Exchange Plan","72.00%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","5","77305","SC","Individual","Yes","43-0908349","77305SC0050001","Delta Dental Individual - Basic Pediatric PPO Plan","77305SC005","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$37.18",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0050001-00","Standard Low Off Exchange Plan","69.60%",,,,"Yes","53%","47%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-04","73% AV Level Silver Plan","73.50%","0.66094970703125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","30%",,,,"Not Applicable","Not Applicable","$2,750","$5,500","$2,750","$20","$1,350","$150","$2,750","$310","$190","$80","19"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-05","87% AV Level Silver Plan","86.10%","0.860921800136566","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$450","$900","20%",,,,"Not Applicable","Not Applicable","$450","$900","$450","$20","$1,360","$150","$450","$490","$240","$80","20"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020049","Bronze 100% HMO HSA Eligible Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72263","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020049-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020049","Bronze 100% HMO HSA Eligible Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72263","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020049-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020050","Bronze 100% HMO HSA Eligible Midlands","41614SC002",,"SCN004","SCS004","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020050-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020050","Bronze 100% HMO HSA Eligible Midlands","41614SC002",,"SCN004","SCS004","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020050-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020050","Bronze 100% HMO HSA Eligible Midlands","41614SC002",,"SCN004","SCS004","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020050-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020051","Bronze 100% HMO HSA Eligible Upstate","41614SC002",,"SCN003","SCS003","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72221","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020051-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","8","41614","SC","Individual","No","20-0229117","41614SC0020051","Bronze 100% HMO HSA Eligible Upstate","41614SC002",,"SCN003","SCS003","SCF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72221","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020051-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-03","Limited Cost Sharing Plan Variation","68.50%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-04","73% AV Level Silver Plan","72.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-05","87% AV Level Silver Plan","86.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020040","Silver $10 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF003","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72230","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020040-06","94% AV Level Silver Plan","93.20%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-01","Standard Silver On Exchange Plan","68.10%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-03","Limited Cost Sharing Plan Variation","68.10%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-04","73% AV Level Silver Plan","72.10%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%","$4,750","$9,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$1,000","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","4","41614","SC","Individual","No","20-0229117","41614SC0020041","Silver $10 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF008","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020041-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%","$1,250","$2,500","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020044","Bronze $15 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72262","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020044-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020044","Bronze $15 Copay POS Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72262","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020044-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020045","Bronze $15 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020045-01","Standard Bronze On Exchange Plan","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020045","Bronze $15 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020045-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020045","Bronze $15 Copay POS Midlands","41614SC002",,"SCN004","SCS004","SCF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020045-03","Limited Cost Sharing Plan Variation","61.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020046","Bronze $15 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72220","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020046-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020046","Bronze $15 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72220","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020046-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"14"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","6","41614","SC","Individual","No","20-0229117","41614SC0020046","Bronze $15 Copay POS Upstate","41614SC002",,"SCN003","SCS003","SCF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72220","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posupdatesc","www.c1formularyhix.com","41614SC0020046-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","7","41614","SC","Individual","No","20-0229117","41614SC0020047","Bronze 100% POS HSA Eligible Plan","41614SC002",,"SCN005","SCS005","SCF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020047-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","9","41614","SC","Individual","No","20-0229117","41614SC0020052","Catastrophic 100% POS Plan","41614SC002",,"SCN005","SCS005","SCF001","New","POS","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Out-of-network benefit","Yes","Out-of-network benefit","No","http://www.coventryhealthcare.com/SC72200","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possc","www.c1formularyhix.com","41614SC0020052-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","10","41614","SC","Individual","No","20-0229117","41614SC0020053","Catastrophic 100% HMO Regional HealthPlus","41614SC002",,"SCN001","SCS001","SCF001","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72242","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posregionalsc","www.c1formularyhix.com","41614SC0020053-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","10","41614","SC","Individual","No","20-0229117","41614SC0020054","Catastrophic 100% HMO Roper St. Francis","41614SC002",,"SCN002","SCS002","SCF001","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","All except OB/GYN and mental health",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72256","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posroperstfrancissc","www.c1formularyhix.com","41614SC0020054-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-03","Limited Cost Sharing Plan Variation","68.10%","0.680950701236725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-04","73% AV Level Silver Plan","72.13%","0.721290111541748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$18,750","$37,500","$23,150","$46,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"8"
"2014","SC","41614","HIOS","5","2013-10-15 07:27:56","10","41614","SC","Individual","No","20-0229117","41614SC0020055","Catastrophic 100% HMO Midlands","41614SC002",,"SCN004","SCS004","SCF001","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/SC72228","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posmidlandssc","www.c1formularyhix.com","41614SC0020055-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-06","94% AV Level Silver Plan","93.20%","0.937813341617584","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","$150","$300","$150","$10","$710","$150","$150","$210","$130","$80","21"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-01","Standard Silver On Exchange Plan","68.80%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$0","$0","$150","$3,500","$0","$0","$80","22"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-01","Standard Silver On Exchange Plan",,"0.683107376098633","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,500","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$1,500","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-05","87% AV Level Silver Plan",,"0.862481832504272","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","Not Applicable",,,"Not Applicable","Not Applicable","$1,750","Not Applicable","$250","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$250","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-06","94% AV Level Silver Plan",,"0.930489659309387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$450","Not Applicable",,,"Not Applicable","Not Applicable","$450","Not Applicable","$100","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$100","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-00","Standard Silver Off Exchange Plan",,"0.683107376098633","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,500","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$1,500","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","6","49532","SC","Individual","No","57-0768835","49532SC0380011","MyChoice Advantage Gold 1000","49532SC038",,"SCN001","SCS001","SCF007","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380011-00","Standard Gold Off Exchange Plan",,"0.786852478981018","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,000","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$1,000","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320005","BlueCross Bronze B01E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320005-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320005","BlueCross Bronze B01E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320005","BlueCross Bronze B01E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320005-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0180002","BlueCross SHOP Gold P1","14002TN018",,"TNN002","TNS001","TNF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease,  Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out-of-Network benefits apply to out of service area coverage with the exception of Emergency Services","Yes","http://www.bcbst.com/sbc/2014/Grp-Gold",,"www.bcbst.com/SHOPbrochures","http://www.bcbst.com/pharmacy/","14002TN0180002-01","Standard Gold On Exchange Plan","80.80%","80.83%","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$1,000","$2,000","45%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","45%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320002","BlueCross Bronze B02S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320002-00","Standard Bronze Off Exchange Plan","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320002","BlueCross Bronze B02S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320002-01","Standard Bronze On Exchange Plan","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320002","BlueCross Bronze B02S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320002","BlueCross Bronze B02S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320002-03","Limited Cost Sharing Plan Variation","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320006","BlueCross Bronze B02E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320006-01","Standard Bronze On Exchange Plan","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320006","BlueCross Bronze B02E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"$0","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-03","Limited Cost Sharing Plan Variation",,"0.683107376098633","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,500","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$1,500","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","5","49532","SC","Individual","No","57-0768835","49532SC0380009","MyChoice Advantage Silver 1500","49532SC038",,"SCN001","SCS001","SCF006","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380009-04","73% AV Level Silver Plan",,"0.720630526542664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable","$750","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$750","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","3","49532","SC","Individual","No","57-0768835","49532SC0380003","MyChoice Advantage Bronze 6350","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380003-01","Standard Bronze On Exchange Plan",,"0.6043940782547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","3","49532","SC","Individual","No","57-0768835","49532SC0380003","MyChoice Advantage Bronze 6350","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,"6"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","3","49532","SC","Individual","No","57-0768835","49532SC0380003","MyChoice Advantage Bronze 6350","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380003-03","Limited Cost Sharing Plan Variation",,"0.6043940782547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-00","Standard Silver Off Exchange Plan",,"0.686743795871735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$2,500","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-03","Limited Cost Sharing Plan Variation",,"0.686743795871735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$2,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$2,500","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-04","73% AV Level Silver Plan",,"0.724437415599823","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable","$1,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$1,500","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320001","BlueCross Bronze B01S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320001-00","Standard Bronze Off Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320001","BlueCross Bronze B01S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320001-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320001","BlueCross Bronze B01S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","3","77305","SC","Individual","Yes","43-0908349","77305SC0030001","Delta Dental Individual and Family, Premier - Basic","77305SC003","7497758624","SCN001","SCS001",,"New","Indemnity","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$48.03",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/individual/Premier_Basic","https://www.deltadentalsc.com/individual/Premier_Basic_Enroll","https://www.deltadentalsc.com/individual/Premier_Basic",,"77305SC0030001-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","3","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0090001","Delta Dental Premier - Basic Plan","77305SC009","7497758624","SCN001","SCS001",,"New","Indemnity","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$26.15",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/shop/Premier_Basic_Plan","https://www.deltadentalsc.com/shop/Premier_Basic_Plan_Enroll","https://www.deltadentalsc.com/shop/Premier_Basic_Plan",,"77305SC0090001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-03","Limited Cost Sharing Plan Variation",,"0.680733859539032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,750","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$1,750","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-03","Limited Cost Sharing Plan Variation","70.93%","0.70927506685257","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-04","73% AV Level Silver Plan","72.94%","0.729394316673279","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-05","87% AV Level Silver Plan","86.46%","0.864646136760712","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,750","$37,500","$20,250","$40,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-06","94% AV Level Silver Plan","93.19%","0.931876420974731","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$18,750","$37,500","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","7","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0130001","Delta Dental PPO - Basic Pediatric 3","77305SC013","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$22.38",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0130001-00","Standard Low Off Exchange Plan","70.90%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","8","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0140001","Delta Dental PPO - Basic Pediatric 4","77305SC014","7497758624","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$21.18",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0140001-00","Standard Low Off Exchange Plan","68.10%",,,,"Yes","31%","69%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$75","Not Applicable",,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-04","73% AV Level Silver Plan","72.03%","0.720305323600769","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$19,050","$38,100","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-05","87% AV Level Silver Plan","86.34%","0.863373041152954","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-05","87% AV Level Silver Plan",,"0.863001465797424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable","$250","Not Applicable","15%",,,,"Not Applicable","Not Applicable","$250","Not Applicable","$0","Not Applicable","15%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380007","MyChoice Advantage Silver 2502","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380007-06","94% AV Level Silver Plan",,"0.930843889713287","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","Not Applicable",,,"Not Applicable","Not Applicable","$500","Not Applicable","$250","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$250","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","Individual","No","57-0768835","49532SC0380002","MyChoice Advantage Bronze 5002","49532SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380002-01","Standard Bronze On Exchange Plan",,"0.581771969795227","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable","$5,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370008","Business Advantage Gold 1000","49532SC037",,"SCN002","SCS001","SCF007","New","PPO","Gold","No","Both","Yes","Yes","A Physician who is not a Primary Care Physician",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCSGLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0370008-01","Standard Gold On Exchange Plan",,"0.786852478981018","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,950","10%",,,,"Not Applicable","Not Applicable","$1,000","$1,950","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","Individual","No","57-0768835","49532SC0380002","MyChoice Advantage Bronze 5002","49532SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","Individual","No","57-0768835","49532SC0380002","MyChoice Advantage Bronze 5002","49532SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380002-03","Limited Cost Sharing Plan Variation",,"0.581771969795227","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable","$5,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","3","49532","SC","Individual","No","57-0768835","49532SC0380003","MyChoice Advantage Bronze 6350","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380003-00","Standard Bronze Off Exchange Plan",,"0.6043940782547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-00","Standard Silver Off Exchange Plan",,"0.680733859539032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,750","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$1,750","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-06","94% AV Level Silver Plan","93.37%","0.933690011501312","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$550","$1,100",,,"$19,050","$38,100","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-01","Standard Silver On Exchange Plan","70.93%","0.70927506685257","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","6","49532","SC","Individual","No","57-0768835","49532SC0380011","MyChoice Advantage Gold 1000","49532SC038",,"SCN001","SCS001","SCF007","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","6","49532","SC","Individual","No","57-0768835","49532SC0380011","MyChoice Advantage Gold 1000","49532SC038",,"SCN001","SCS001","SCF007","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380011-03","Limited Cost Sharing Plan Variation",,"0.786852478981018","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,000","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$1,000","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","7","49532","SC","Individual","No","57-0768835","49532SC0380004","MyChoice Advantage Core 6351","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","7","49532","SC","Individual","No","57-0768835","49532SC0380004","MyChoice Advantage Core 6351","49532SC038",,"SCN001","SCS001","SCF003","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,"5"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","9","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0150001","Delta Dental PPO - Preferred Pediatric 1","77305SC015","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$27.28",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0150001-00","Standard High Off Exchange Plan","83.70%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","10","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0160001","Delta Dental PPO - Preferred Pediatric 2","77305SC016","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$27.48",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0160001-00","Standard High Off Exchange Plan","84.60%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$50","Not Applicable",,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-05","87% AV Level Silver Plan","86.12%","0.861231207847595","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,050","$38,100","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-06","94% AV Level Silver Plan","93.37%","0.933690011501312","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$550","$1,100",,,"$19,050","$38,100","$19,600","$39,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-00","Standard Silver Off Exchange Plan","68.10%","0.680950701236725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-01","Standard Silver On Exchange Plan","68.10%","0.680950701236725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330002","BlueCross Silver S02S","14002TN033",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-01","Standard Silver On Exchange Plan","68.10%","0.680950701236725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-03","Limited Cost Sharing Plan Variation","68.10%","0.680950701236725","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"13"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","1","77305","SC","Individual","Yes","43-0908349","77305SC0010001","Delta Dental Individual and Family, PPO-Exclusive - Basic","77305SC001","7497758624","SCN002","SCS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$37.59",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/individual/PPO_Basic","https://www.deltadentalsc.com/individual/PPO_Basic_Enroll","https://www.deltadentalsc.com/individual/PPO_Basic",,"77305SC0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","1","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0070001","Delta Dental PPO-Exclusive - Basic Plan","77305SC007","7497758624","SCN002","SCS001",,"New","EPO","Low",,"On the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Adult and Child-Only",,,,"$20.78",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same as in service area","Yes","https://www.deltadentalsc.com/shop/PPO_Basic_Plan","https://www.deltadentalsc.com/shop/PPO_Basic_Plan_Enroll","https://www.deltadentalsc.com/shop/PPO_Basic_Plan",,"77305SC0070001-01","Standard Low On Exchange Plan","69.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380001","MyChoice Advantage Bronze 5001","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380001-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-00","Standard Silver Off Exchange Plan",,"0.683563947677612","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-01","Standard Silver On Exchange Plan",,"0.683563947677612","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"10"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-03","Limited Cost Sharing Plan Variation",,"0.683563947677612","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-04","73% AV Level Silver Plan",,"0.723980605602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","Not Applicable",,,"Not Applicable","Not Applicable","$5,100","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-05","87% AV Level Silver Plan",,"0.864971578121185","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$75","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380005","MyChoice Advantage Silver 400","49532SC038",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380005-06","94% AV Level Silver Plan",,"0.930382549762726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","Not Applicable",,,"Not Applicable","Not Applicable","$850","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$75","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-00","Standard Silver Off Exchange Plan",,"0.680481553077698","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,650","Not Applicable",,,"Not Applicable","Not Applicable","$5,650","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-01","Standard Silver On Exchange Plan",,"0.680481553077698","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,650","Not Applicable",,,"Not Applicable","Not Applicable","$5,650","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"17"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-03","Limited Cost Sharing Plan Variation",,"0.680481553077698","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,650","Not Applicable",,,"Not Applicable","Not Applicable","$5,650","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-04","73% AV Level Silver Plan",,"0.720474004745483","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,150","Not Applicable",,,"Not Applicable","Not Applicable","$5,150","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,850","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-05","87% AV Level Silver Plan",,"0.863398253917694","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","Not Applicable",,,"Not Applicable","Not Applicable","$1,500","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","Not Applicable","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","1","49532","SC","Individual","No","57-0768835","49532SC0380006","MyChoice Advantage Silver 2501","49532SC038",,"SCN001","SCS001","SCF004","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380006-06","94% AV Level Silver Plan",,"0.93122661113739","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$675","Not Applicable",,,"Not Applicable","Not Applicable","$675","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","Not Applicable","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","Individual","No","57-0768835","49532SC0380002","MyChoice Advantage Bronze 5002","49532SC038",,"SCN001","SCS001","SCF002","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380002-00","Standard Bronze Off Exchange Plan",,"0.581771969795227","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","Not Applicable",,,"Not Applicable","Not Applicable","$6,250","Not Applicable","$5,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","2","49532","SC","SHOP (Small Group)","No","57-0768835","49532SC0370008","Business Advantage Gold 1000","49532SC037",,"SCN002","SCS001","SCF007","New","PPO","Gold","No","Both","Yes","Yes","A Physician who is not a Primary Care Physician",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCSGLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0370008-00","Standard Gold Off Exchange Plan",,"0.786852478981018","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,950","10%",,,,"Not Applicable","Not Applicable","$1,000","$1,950","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-01","Standard Silver On Exchange Plan",,"0.680733859539032","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,750","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$1,750","Not Applicable","$0","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","4","49532","SC","Individual","No","57-0768835","49532SC0380008","MyChoice Advantage Silver 1750","49532SC038",,"SCN001","SCS001","SCF005","New","EPO","Silver","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380008-04","73% AV Level Silver Plan",,"0.721798181533813","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable","$1,500","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,500","Not Applicable","$0","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","SC","49532","HIOS","6","2014-03-19 07:06:49","6","49532","SC","Individual","No","57-0768835","49532SC0380011","MyChoice Advantage Gold 1000","49532SC038",,"SCN001","SCS001","SCF007","New","EPO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","Emergency care and urgent care obtained outside the geographic areas we serve.  Any other services will not be covered when processed through any Inter-Plan Programs arrangements.  These ""other services"" must be provided or Authorized by your primary care physician (""PCP"").","Yes","http://www.bluechoicesc.com/UserFiles/bluechoice/Documents/Everybody/SBCIndLinks.pdf",,,"http://www.bluechoicesc.com/productsservices/prescriptiondruginformation.aspx","49532SC0380011-01","Standard Gold On Exchange Plan",,"0.786852478981018","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","Not Applicable","$1,000","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$1,000","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","54362","HIOS","2","2013-07-01 08:34:30","1","54362","SC","Individual","Yes","59-1031071","54362SC0030001","myCigna Dental Pediatric","54362SC003","7730182962","SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$29.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"54362SC0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020001","CCHP 1","65122SC002",,"SCN001","SCS001","SCF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020001/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020001/","http://www.cchpsc.org/members/formulary/","65122SC0020001-01","Standard Platinum On Exchange Plan","88.60%","0.895972430706024","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$20","$700","$150","$250","$550","$120","$80","4"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010001","Consumers' Choice Gold 1","65122SC001",,"SCN001","SCS001","SCF006","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/formulary/","65122SC0010001-01","Standard Gold On Exchange Plan",,"0.811419427394867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$600","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","4"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020002","CCHP 2","65122SC002",,"SCN001","SCS001","SCF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020002/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020002/","http://www.cchpsc.org/members/formulary/","65122SC0020002-01","Standard Gold On Exchange Plan","81.90%","0.818774461746216","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,000",,,"Not Applicable","Not Applicable","$4,750","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","5"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010001","Consumers' Choice Gold 1","65122SC001",,"SCN001","SCS001","SCF006","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/formulary/","65122SC0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020003","CCHP 3","65122SC002",,"SCN001","SCS001","SCF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020003/","http://www.cchpsc.org/members/formulary/","65122SC0020003-01","Standard Gold On Exchange Plan","79.50%","0.759084522724152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","$1,250","$2,500","$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","6"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010001","Consumers' Choice Gold 1","65122SC001",,"SCN001","SCS001","SCF006","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010001/","http://www.cchpsc.org/members/formulary/","65122SC0010001-03","Limited Cost Sharing Plan Variation",,"0.811419427394867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$600","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","6"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020004","CCHP HDP 1","65122SC002",,"SCN001","SCS001","SCF015","New","EPO","Gold","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020004/","http://www.cchpsc.org/members/formulary/","65122SC0020004-01","Standard Gold On Exchange Plan",,"0.781938672065735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$0","$580","$150","$1,500","$50","$330","$80","7"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010002","Consumers' Choice Gold 2","65122SC001",,"SCN001","SCS001","SCF005","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/formulary/","65122SC0010002-01","Standard Gold On Exchange Plan","79.80%","0.771713137626648","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$100","$20","$1,880","$150","$1,000","$500","$320","$80","7"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020005","CCHP 4","65122SC002",,"SCN001","SCS001","SCF008","New","EPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020005/","http://www.cchpsc.org/members/formulary/","65122SC0020005-01","Standard Silver On Exchange Plan","71.90%","0.667916059494019","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,250","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","8"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010002","Consumers' Choice Gold 2","65122SC001",,"SCN001","SCS001","SCF005","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/formulary/","65122SC0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020006","CCHP 5","65122SC002",,"SCN001","SCS001","SCF009","New","EPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020006/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020006/","http://www.cchpsc.org/members/formulary/","65122SC0020006-01","Standard Silver On Exchange Plan","69.20%","0.650942504405975","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$2,100","$150","$2,000","$460","$370","$80","9"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010002","Consumers' Choice Gold 2","65122SC001",,"SCN001","SCS001","SCF005","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010002/","http://www.cchpsc.org/members/formulary/","65122SC0010002-03","Limited Cost Sharing Plan Variation","79.80%","0.771713137626648","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$100","$20","$1,880","$150","$1,000","$500","$320","$80","9"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020007","CCHP HDP 2","65122SC002",,"SCN001","SCS001","SCF014","New","EPO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020007/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020007/","http://www.cchpsc.org/members/formulary/","65122SC0020007-01","Standard Silver On Exchange Plan",,"0.709602534770966","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","$5,250","$10,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$0","$1,110","$150","$1,750","$0","$700","$80","10"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-01","Standard Silver On Exchange Plan","72.00%","0.674369394779205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","10"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","SHOP (Small Group)","No","45-3124969","65122SC0020008","CCHP 6","65122SC002",,"SCN001","SCS001","SCF012","New","EPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0020008/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0020008/","http://www.cchpsc.org/members/formulary/","65122SC0020008-01","Standard Bronze On Exchange Plan",,"0.595439195632935","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,250","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","11"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-03","Limited Cost Sharing Plan Variation","72.00%","0.674727618694305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","12"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-04","73% AV Level Silver Plan","74.00%","0.691850781440735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$390","$280","$80","13"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-05","87% AV Level Silver Plan","87.30%","0.880039274692535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$20","$1,400","$150","$250","$500","$240","$80","14"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010003","Consumers' Choice Silver 1","65122SC001",,"SCN001","SCS001","SCF024","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010003/","http://www.cchpsc.org/members/formulary/","65122SC0010003-06","94% AV Level Silver Plan","94.00%","0.946276545524597","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$75","$150","10%",,,,"Not Applicable","Not Applicable","$75","$150","$70","$10","$720","$150","$80","$210","$1,300","$80","15"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-01","Standard Silver On Exchange Plan","70.30%","0.626614630222321","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$20","$1,130","$150","$3,500","$200","$160","$80","16"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010004","Consumers' Choice Silver 2","65122SC001",,"SCN001","SCS001","SCF010","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010004/","http://www.cchpsc.org/members/formulary/","65122SC0010004-03","Limited Cost Sharing Plan Variation","70.30%","0.626614630222321","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$20","$1,130","$150","$3,500","$200","$160","$80","18"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010005","Consumers' Choice Silver HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010005/","http://www.cchpsc.org/members/formulary/","65122SC0010005-06","94% AV Level Silver Plan","93.80%","0.933583498001099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","0%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$0","$250","$150","$250","$0","$250","$80","27"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010006","Consumers' Choice Bronze 1","65122SC001",,"SCN001","SCS001","SCF012","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/formulary/","65122SC0010006-01","Standard Bronze On Exchange Plan",,"0.596092998981476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,200","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","28"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010006","Consumers' Choice Bronze 1","65122SC001",,"SCN001","SCS001","SCF012","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/formulary/","65122SC0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010006","Consumers' Choice Bronze 1","65122SC001",,"SCN001","SCS001","SCF012","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010006/","http://www.cchpsc.org/members/formulary/","65122SC0010006-03","Limited Cost Sharing Plan Variation",,"0.596092998981476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,200","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","30"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010007","Consumers' Choice Bronze HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/formulary/","65122SC0010007-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","$6,250","$12,500","$6,250","$0","$0","$150","$5,270","$0","$0","$80","31"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010007","Consumers' Choice Bronze HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/formulary/","65122SC0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010007","Consumers' Choice Bronze HDP 1","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010007/","http://www.cchpsc.org/members/formulary/","65122SC0010007-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","$6,250","$12,500","$6,250","$0","$0","$150","$5,270","$0","$0","$80","33"
"2014","SC","65122","HIOS","5","2013-09-10 14:43:20","1","65122","SC","Individual","No","45-3124969","65122SC0010008","Consumers' Choice Value Plan","65122SC001",,"SCN001","SCS001","SCF011","New","EPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.cchpsc.org/members/plans/65122sc0010008/","http://www.cchpsc.org/members/payments/","http://www.cchpsc.org/members/plans/65122sc0010008/","http://www.cchpsc.org/members/formulary/","65122SC0010008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,400","$12,800","$6,350","$0","$0","$150","$5,270","$0","$0","$80","34"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0010002","Delta Dental Individual PPO, EHB Certified","97325SC001",,"SCN002","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_EHB_Group_High",,"www.renaissancedental.com/SC_EHB_Group_High",,"97325SC0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0020001","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010006","BEST Dental Basic - Silver","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Basic_Plan_(Silver).pdf",,"89281SC0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010006","BEST Dental Basic - Silver","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Basic_Plan_(Silver).pdf",,"89281SC0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","Individual","Yes","95-6042390","89281SC0020006","BESTOne Dental Basic - Silver","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"89281SC0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0020002","Renaissance Individual Dental PPO, EHB Certified","97325SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_EHB_Group_Low",,"www.renaissancedental.com/SC_EHB_Group_Low",,"97325SC0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_EHB_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","www.renaissancedental.com/SC_EHB_Plan_Brochure",,"97325SC0060001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_50_50_High",,"www.renaissancedental.com/SC_50_50_High",,"97325SC0080003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","SHOP (Small Group)","Yes","47-0397286","97325SC0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","97325SC008",,"SCN001","SCS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_50_50_Low",,"www.renaissancedental.com/SC_50_50_Low",,"97325SC0080004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","1","97325","SC","Individual","Yes","47-0397286","97325SC0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","97325SC006",,"SCN001","SCS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_EHB_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","www.renaissancedental.com/SC_EHB_Plan_Brochure",,"97325SC0060002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","2","97325","SC","Individual","Yes","47-0397286","97325SC0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","2","97325","SC","Individual","Yes","47-0397286","97325SC0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","97325SC005",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.13",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"97325SC0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","2","97325","SC","Individual","Yes","47-0397286","97325SC0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$31.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_Ped_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","www.renaissancedental.com/SC_EHB_Plan_Brochure",,"97325SC0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","97325","HIOS","7","2013-11-26 13:14:08","2","97325","SC","Individual","Yes","47-0397286","97325SC0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","97325SC007",,"SCN001","SCS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/SC_Ped_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/97325","www.renaissancedental.com/SC_EHB_Plan_Brochure",,"97325SC0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","SHOP (Small Group)","No","62-0427913","14002TN0180001","BlueCross SHOP Silver P1","14002TN018",,"TNN002","TNS001","TNF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out-of-Network benefits apply to out of service area coverage with the exception of Emergency Services","Yes","http://www.bcbst.com/sbc/2014/Grp-Silver",,"www.bcbst.com/SHOPbrochures","http://www.bcbst.com/pharmacy/","14002TN0180001-01","Standard Silver On Exchange Plan","71.80%","71.80%","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$2,000","$4,000","45%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320008","BlueCross Bronze B04E","14002TN032",,"TNN003","TNS002","TNF010","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320008-03","Limited Cost Sharing Plan Variation","61.80%","0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-00","Standard Silver Off Exchange Plan","70.93%","0.70927506685257","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-01","Standard Silver On Exchange Plan","70.93%","0.70927506685257","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-03","Limited Cost Sharing Plan Variation","70.93%","0.70927506685257","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-04","73% AV Level Silver Plan","72.94%","0.729394316673279","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330001","BlueCross Silver S01S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330001-05","87% AV Level Silver Plan","86.12%","0.861231207847595","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$19,050","$38,100","$20,500","$41,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","5","14002","TN","Individual","No","62-0427913","14002TN0330011","BlueCross Silver S01E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","11","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0170001","Delta Dental PPO - Preferred Pediatric 3","77305SC017","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$27.86",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0170001-00","Standard High Off Exchange Plan","85.30%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$25","Not Applicable",,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010005","BEST Dental Plus - Silver","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Plus_Plan_(Silver).pdf",,"89281SC0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","Individual","Yes","95-6042390","89281SC0020005","BESTOne Dental Plus - Silver","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"89281SC0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","Individual","Yes","95-6042390","89281SC0020006","BESTOne Dental Basic - Silver","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"89281SC0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","1","14002","TN","Individual","No","62-0427913","14002TN0320001","BlueCross Bronze B01S","14002TN032",,"TNN001","TNS001","TNF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320001-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","2","14002","TN","Individual","No","62-0427913","14002TN0320006","BlueCross Bronze B02E","14002TN032",,"TNN003","TNS002","TNF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320006-03","Limited Cost Sharing Plan Variation","59.31%","0.593126475811005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320003","BlueCross Bronze B03S","14002TN032",,"TNN001","TNS001","TNF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320003-00","Standard Bronze Off Exchange Plan","61.51%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","SC","77305","HIOS","7","2013-11-26 13:14:08","12","77305","SC","SHOP (Small Group)","Yes","43-0908349","77305SC0180001","Delta Dental PPO - Preferred Pediatric 4","77305SC018","7497758624","SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"Coverage for pre-existing conditions is excluded for Basic Dental Care and Major Dental Care for children and adults. Medically necessary orthodontia coverage is limited to coverage for children only, after a 24-month waiting period.",,,,,"Allows Child-Only",,,,"$27.66",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in USA","Yes","Same as in service area","Yes","www.deltadentalsc.com","www.deltadentalsc.com","www.deltadentalsc.com",,"77305SC0180001-00","Standard High Off Exchange Plan","84.30%",,,,"Yes","28%","72%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,"$25","Not Applicable",,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84589","HIOS","2","2013-08-01 12:48:00","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010001","DentalConnect�","84589SC001",,"SCN001","SCS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"84589SC0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84589","HIOS","2","2013-08-01 12:48:00","1","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010002","DentalConnect�","84589SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.15",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"84589SC0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","84589","HIOS","2","2013-08-01 12:48:00","2","84589","SC","SHOP (Small Group)","Yes","35-0472300","84589SC0010003","DentalConnect�","84589SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"84589SC0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0110001","Guardian Pediatric Advantage","84939SC011",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0110001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0110001","Guardian Pediatric Advantage","84939SC011",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0110001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0120001","Guardian Pediatric Essentials","84939SC012",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","1","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0120001","Guardian Pediatric Essentials","84939SC012",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0130001","Guardian Family Advantage Plus","84939SC013",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0130001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","2","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0130001","Guardian Family Advantage Plus","84939SC013",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0130001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","3","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0150001","Guardian Family Essentials Plus","84939SC015",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage available outside service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0150001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-04","73% AV Level Silver Plan","72.13%","0.721290111541748","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$18,750","$37,500","$23,150","$46,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$2,000","$4,000","$3,000","$6,000",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-05","87% AV Level Silver Plan","86.46%","0.864646136760712","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,750","$37,500","$20,250","$40,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","6","14002","TN","Individual","No","62-0427913","14002TN0330012","BlueCross Silver S02E","14002TN033",,"TNN003","TNS002","TNF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330012-06","94% AV Level Silver Plan","93.19%","0.931876420974731","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$18,750","$37,500","$19,350","$38,700",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-00","Standard Silver Off Exchange Plan","68.16%","0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-01","Standard Silver On Exchange Plan","68.16%","0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-03","Limited Cost Sharing Plan Variation","68.16%","0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-04","73% AV Level Silver Plan","72.05%","0.72050142288208","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$12,000","$24,000","$15,650","$31,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$4,000","$8,000","$5,000","$10,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-05","87% AV Level Silver Plan","86.12%","0.861231207847595","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","3","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0150001","Guardian Family Essentials Plus","84939SC015",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage available outside service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0150001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","4","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0140001","Guardian Family Advantage","84939SC014",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0140001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","4","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0140001","Guardian Family Advantage","84939SC014",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0140001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-04","73% AV Level Silver Plan","72.01%","0.720056891441345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$15,000","$30,000","$18,650","$37,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-05","87% AV Level Silver Plan","86.25%","0.862463176250458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$15,000","$30,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$4,000","$8,000","$4,300","$8,600",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-06","94% AV Level Silver Plan","93.17%","0.93165785074234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$15,000","$30,000","$15,800","$31,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-01","Standard Silver On Exchange Plan","69.89%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340012","BlueCross Gold G06E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340012","BlueCross Gold G06E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340012-03","Limited Cost Sharing Plan Variation","79.10%","0.791000127792358","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340005","BlueCross Gold G08S","14002TN034",,"TNN001","TNS001","TNF010","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340005-00","Standard Gold Off Exchange Plan","78.05%","0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340005","BlueCross Gold G08S","14002TN034",,"TNN001","TNS001","TNF010","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340005-01","Standard Gold On Exchange Plan","78.05%","0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340005","BlueCross Gold G08S","14002TN034",,"TNN001","TNS001","TNF010","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340005","BlueCross Gold G08S","14002TN034",,"TNN001","TNS001","TNF010","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340005-03","Limited Cost Sharing Plan Variation","78.05%","0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"7"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","4","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0160001","Guardian Family Essentials","84939SC016",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","84939","HIOS","4","2013-09-02 11:39:25","4","84939","SC","SHOP (Small Group)","Yes","13-5123390","84939SC0160001","Guardian Family Essentials","84939SC016",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"84939SC0160001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","84966","HIOS","3","2013-08-09 08:21:29","1","84966","SC","SHOP (Small Group)","Yes","13-5581829","84966SC0120001","EHB Basic Dental Plan (Low)","84966SC012",,"SCN001","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$16.67",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"84966SC0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84966","HIOS","3","2013-08-09 08:21:29","2","84966","SC","SHOP (Small Group)","Yes","13-5581829","84966SC0130001","EHB Enhanced Dental Plan (High)","84966SC013",,"SCN002","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"84966SC0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84966","HIOS","3","2013-08-09 08:21:29","3","84966","SC","SHOP (Small Group)","Yes","13-5581829","84966SC0140001","Family Basic Dental Plan (Low)","84966SC014",,"SCN003","SCS001",,"New","PPO","Low",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$16.67",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"84966SC0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","84966","HIOS","3","2013-08-09 08:21:29","4","84966","SC","SHOP (Small Group)","Yes","13-5581829","84966SC0150001","Family Enhanced Dental Plan (High)","84966SC015",,"SCN004","SCS001",,"New","PPO","High",,"Off the Exchange",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,,,"84966SC0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010001","BEST Life Child Dental Plus","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Child_Dental_Plus_Plan.pdf",,"89281SC0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","1","89281","SC","Individual","Yes","95-6042390","89281SC0020001","BESTOne Child Dental Plus","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Child_Dental_Plus_Plan.pdf",,"89281SC0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","1","89281","SC","Individual","Yes","95-6042390","89281SC0020001","BESTOne Child Dental Plus","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Child_Dental_Plus_Plan.pdf",,"89281SC0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","1","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010001","BEST Life Child Dental Plus","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Child_Dental_Plus_Plan.pdf",,"89281SC0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010002","BEST Life Child Dental","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Child_Dental_Plan.pdf",,"89281SC0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","2","89281","SC","Individual","Yes","95-6042390","89281SC0020002","BESTOne Child Dental","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Child_Dental_Plan.pdf",,"89281SC0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","2","89281","SC","Individual","Yes","95-6042390","89281SC0020002","BESTOne Child Dental","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Child_Dental_Plan.pdf",,"89281SC0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","2","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010002","BEST Life Child Dental","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Child_Dental_Plan.pdf",,"89281SC0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010003","BEST Dental Advantage - Gold","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Advantage_Plan_(Gold).pdf",,"89281SC0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","Individual","Yes","95-6042390","89281SC0020003","BESTOne Dental Advantage - Gold","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"89281SC0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","Individual","Yes","95-6042390","89281SC0020003","BESTOne Dental Advantage - Gold","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"89281SC0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010003","BEST Dental Advantage - Gold","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Advantage_Plan_(Gold).pdf",,"89281SC0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","Individual","Yes","95-6042390","89281SC0020004","BESTOne Dental Plus - Gold","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"89281SC0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010004","BEST Dental Plus - Gold","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Plus_Plan_(Gold).pdf",,"89281SC0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010004","BEST Dental Plus - Gold","89281SC001",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Plus_Plan_(Gold).pdf",,"89281SC0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","3","89281","SC","Individual","Yes","95-6042390","89281SC0020004","BESTOne Dental Plus - Gold","89281SC002",,"SCN001","SCS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"89281SC0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","Individual","Yes","95-6042390","89281SC0020005","BESTOne Dental Plus - Silver","89281SC002",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"89281SC0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SC","89281","HIOS","8","2014-01-21 08:29:49","4","89281","SC","SHOP (Small Group)","Yes","95-6042390","89281SC0010005","BEST Dental Plus - Silver","89281SC001",,"SCN001","SCS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SC/pdf/SC_BEST_Dental_Plus_Plan_(Silver).pdf",,"89281SC0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320003","BlueCross Bronze B03S","14002TN032",,"TNN001","TNS001","TNF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320003-01","Standard Bronze On Exchange Plan","61.51%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320003","BlueCross Bronze B03S","14002TN032",,"TNN001","TNS001","TNF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320003","BlueCross Bronze B03S","14002TN032",,"TNN001","TNS001","TNF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320003-03","Limited Cost Sharing Plan Variation","61.51%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320007","BlueCross Bronze B03E","14002TN032",,"TNN003","TNS002","TNF009","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320007-01","Standard Bronze On Exchange Plan","61.51%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"8"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030006","Community Health Bronze 1","66842TN003",,"TNN001","TNS001","TNF012","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/formulary/","66842TN0030006-01","Standard Bronze On Exchange Plan",,"0.598820626735687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","34"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030006","Community Health Bronze 1","66842TN003",,"TNN001","TNS001","TNF012","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/formulary/","66842TN0030006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"35"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030006","Community Health Bronze 1","66842TN003",,"TNN001","TNS001","TNF012","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/formulary/","66842TN0030006-03","Limited Cost Sharing Plan Variation",,"0.598820626735687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","36"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030007","Community Health Bronze HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/formulary/","66842TN0030007-00","Standard Bronze Off Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","$6,250","$12,500","$6,250","$0","$0","$150","$5,270","$0","$0","$80","37"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030007","Community Health Bronze HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/formulary/","66842TN0030007-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","$6,250","$12,500","$6,250","$0","$0","$150","$5,270","$0","$0","$80","38"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030007","Community Health Bronze HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/formulary/","66842TN0030007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"39"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-05","87% AV Level Silver Plan","86.05%","0.860458195209503","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","$8,750","$17,500",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-06","94% AV Level Silver Plan","93.01%","0.930114090442657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-00","Standard Silver Off Exchange Plan","71.96%","0.719600379467011","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-01","Standard Silver On Exchange Plan","71.96%","0.719600379467011","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-03","Limited Cost Sharing Plan Variation","69.89%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320007","BlueCross Bronze B03E","14002TN032",,"TNN003","TNS002","TNF009","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","3","14002","TN","Individual","No","62-0427913","14002TN0320007","BlueCross Bronze B03E","14002TN032",,"TNN003","TNS002","TNF009","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320007-03","Limited Cost Sharing Plan Variation","61.51%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320004","BlueCross Bronze B04S","14002TN032",,"TNN001","TNS001","TNF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320004-00","Standard Bronze Off Exchange Plan","61.80%","0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320004","BlueCross Bronze B04S","14002TN032",,"TNN001","TNS001","TNF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320004-01","Standard Bronze On Exchange Plan","61.80%","0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320004","BlueCross Bronze B04S","14002TN032",,"TNN001","TNS001","TNF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320004","BlueCross Bronze B04S","14002TN032",,"TNN001","TNS001","TNF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320004-03","Limited Cost Sharing Plan Variation","61.80%","0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320008","BlueCross Bronze B04E","14002TN032",,"TNN003","TNS002","TNF010","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320008-01","Standard Bronze On Exchange Plan","61.80%","0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","4","14002","TN","Individual","No","62-0427913","14002TN0320008","BlueCross Bronze B04E","14002TN032",,"TNN003","TNS002","TNF010","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0320008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-03","Limited Cost Sharing Plan Variation","68.16%","0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-04","73% AV Level Silver Plan","72.05%","0.72050142288208","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$12,000","$24,000","$15,650","$31,300",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","50%",,,,"$4,000","$8,000","$5,000","$10,000",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-05","87% AV Level Silver Plan","86.12%","0.861231207847595","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$12,000","$24,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-06","94% AV Level Silver Plan","93.37%","0.933690011501312","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$550","$1,100",,,"$12,000","$24,000","$12,550","$25,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-00","Standard Silver Off Exchange Plan","68.24%","0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-01","Standard Silver On Exchange Plan","68.24%","0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-03","Limited Cost Sharing Plan Variation","68.24%","0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-04","73% AV Level Silver Plan","72.03%","0.720305323600769","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,950","$7,900",,,"$19,050","$38,100","$23,000","$46,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-05","87% AV Level Silver Plan","86.34%","0.863373041152954","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330004","BlueCross Silver S07S","14002TN033",,"TNN001","TNS001","TNF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330004-06","94% AV Level Silver Plan","93.22%","0.932236790657043","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$19,050","$38,100","$19,700","$39,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330003","BlueCross Silver S04S","14002TN033",,"TNN001","TNS001","TNF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330003-06","94% AV Level Silver Plan","93.37%","0.933690011501312","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$550","$1,100",,,"$12,000","$24,000","$12,550","$25,100",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-01","Standard Silver On Exchange Plan","68.16%","0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","7","14002","TN","Individual","No","62-0427913","14002TN0330013","BlueCross Silver S04E","14002TN033",,"TNN003","TNS002","TNF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","8","14002","TN","Individual","No","62-0427913","14002TN0330014","BlueCross Silver S07E","14002TN033",,"TNN003","TNS002","TNF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330014-06","94% AV Level Silver Plan","93.22%","0.932236790657043","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$19,050","$38,100","$19,700","$39,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-00","Standard Silver Off Exchange Plan","69.89%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-01","Standard Silver On Exchange Plan","69.89%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330005","BlueCross Silver S08S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330005-03","Limited Cost Sharing Plan Variation","69.89%","0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-03","Limited Cost Sharing Plan Variation","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-04","73% AV Level Silver Plan","72.07%","0.720732450485229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$8,000","$16,000","$11,000","$22,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-05","87% AV Level Silver Plan","86.05%","0.860458195209503","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","$8,750","$17,500",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-06","94% AV Level Silver Plan","93.01%","0.930114090442657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-01","Standard Silver On Exchange Plan","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-03","Limited Cost Sharing Plan Variation","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330018","BlueCross Silver S12E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330018-04","73% AV Level Silver Plan","72.07%","0.720732450485229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$8,000","$16,000","$11,000","$22,000",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350006","BlueCross Platinum P03E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350006-01","Standard Platinum On Exchange Plan","88.26%","0.882617235183716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-01","Standard Silver On Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-03","Limited Cost Sharing Plan Variation","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340007","BlueCross Gold G10S","14002TN034",,"TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340007-00","Standard Gold Off Exchange Plan","78.56%","0.78556501865387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340007","BlueCross Gold G10S","14002TN034",,"TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340007-01","Standard Gold On Exchange Plan","78.56%","0.78556501865387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340007","BlueCross Gold G10S","14002TN034",,"TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350006","BlueCross Platinum P03E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-04","73% AV Level Silver Plan","73.25%","0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","$2,750","$5,500",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","$2,750","$5,500","$2,750","$0","$0","$150","$2,750","$0","$0","$80","30"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-05","87% AV Level Silver Plan","87.65%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$1,000","$0","$0","$150","$1,000","$0","$0","$80","31"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-06","94% AV Level Silver Plan","93.36%","0.933583498001099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","0%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$0","$0","$150","$250","$0","$0","$80","32"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030006","Community Health Bronze 1","66842TN003",,"TNN001","TNS001","TNF012","New","EPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030006/","http://www.chatn.org/members/formulary/","66842TN0030006-00","Standard Bronze Off Exchange Plan",,"0.598820626735687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","33"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-04","73% AV Level Silver Plan","72.01%","0.720056891441345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$15,000","$30,000","$18,650","$37,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-05","87% AV Level Silver Plan","86.25%","0.862463176250458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$15,000","$30,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$4,000","$8,000","$4,300","$8,600",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","9","14002","TN","Individual","No","62-0427913","14002TN0330015","BlueCross Silver S08E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330015-06","94% AV Level Silver Plan","93.17%","0.93165785074234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$15,000","$30,000","$15,800","$31,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-00","Standard Silver Off Exchange Plan","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-01","Standard Silver On Exchange Plan","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-03","Limited Cost Sharing Plan Variation","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-04","73% AV Level Silver Plan","72.01%","0.720056891441345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$5,000","$10,000","$7,000","$14,000",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-05","87% AV Level Silver Plan","86.25%","0.862463176250458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$5,000","$10,000","$5,300","$10,600",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330006","BlueCross Silver S09S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330006-06","94% AV Level Silver Plan","93.17%","0.93165785074234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340008","BlueCross Gold G11S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340008-00","Standard Gold Off Exchange Plan","79.68%","0.796816885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340008","BlueCross Gold G11S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340008-01","Standard Gold On Exchange Plan","79.68%","0.796816885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340008","BlueCross Gold G11S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340008","BlueCross Gold G11S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340008-03","Limited Cost Sharing Plan Variation","79.68%","0.796816885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340016","BlueCross Gold G11E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340016-01","Standard Gold On Exchange Plan","79.68%","0.796816885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340016","BlueCross Gold G11E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","21","14002","TN","Individual","No","62-0427913","14002TN0340016","BlueCross Gold G11E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340016-03","Limited Cost Sharing Plan Variation","79.68%","0.796816885471344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350001","BlueCross Platinum P01S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350001-00","Standard Platinum Off Exchange Plan","88.25%","0.882483839988709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-04","73% AV Level Silver Plan","72.00%","0.720003962516785","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$10,500","$21,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900","0%",,,,"$7,000","$14,000","$9,950","$19,900",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-05","87% AV Level Silver Plan","86.24%","0.862436950206757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,500","$21,000","$11,650","$23,300",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"$7,000","$14,000","$8,150","$16,300",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-01","Standard Silver On Exchange Plan","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-03","Limited Cost Sharing Plan Variation","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-04","73% AV Level Silver Plan","72.01%","0.720056891441345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$5,000","$10,000","$7,000","$14,000",,,,,,,,,"14"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040002","CHA 2","66842TN004",,"TNN001","TNS001","TNF004","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040002/","http://www.chatn.org/members/formulary/","66842TN0040002-00","Standard Gold Off Exchange Plan","80.75%","0.813973009586334","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","6"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030001","Community Health Gold 1","66842TN003",,"TNN001","TNS001","TNF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/formulary/","66842TN0030001-03","Limited Cost Sharing Plan Variation","81.15%","0.814063489437103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-05","87% AV Level Silver Plan","86.25%","0.862463176250458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$5,000","$10,000","$5,300","$10,600",,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","10","14002","TN","Individual","No","62-0427913","14002TN0330016","BlueCross Silver S09E","14002TN033",,"TNN003","TNS002","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330016-06","94% AV Level Silver Plan","93.17%","0.93165785074234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-00","Standard Silver Off Exchange Plan","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-01","Standard Silver On Exchange Plan","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-03","Limited Cost Sharing Plan Variation","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-04","73% AV Level Silver Plan","72.33%","0.72333550453186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-05","87% AV Level Silver Plan","86.34%","0.863423347473145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000","$500","$1,000","20%",,,,"$5,000","$10,000","$5,500","$11,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330007","BlueCross Silver S11S","14002TN033",,"TNN001","TNS001","TNF012","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330007-06","94% AV Level Silver Plan","93.03%","0.930253565311432","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$16,500","$33,000","$17,250","$34,500","$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-01","Standard Silver On Exchange Plan","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340003","BlueCross Gold G04S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340003-01","Standard Gold On Exchange Plan","81.15%","0.811477065086365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340003","BlueCross Gold G04S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340003","BlueCross Gold G04S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340003-03","Limited Cost Sharing Plan Variation","81.15%","0.811477065086365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340011","BlueCross Gold G04E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340011-01","Standard Gold On Exchange Plan","81.15%","0.811477065086365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340011","BlueCross Gold G04E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340011","BlueCross Gold G04E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340011-03","Limited Cost Sharing Plan Variation","81.15%","0.811477065086365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-03","Limited Cost Sharing Plan Variation","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-04","73% AV Level Silver Plan","72.33%","0.72333550453186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-05","87% AV Level Silver Plan","86.34%","0.863423347473145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000","$500","$1,000","20%",,,,"$5,000","$10,000","$5,500","$11,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","11","14002","TN","Individual","No","62-0427913","14002TN0330017","BlueCross Silver S11E","14002TN033",,"TNN003","TNS002","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330017-06","94% AV Level Silver Plan","93.03%","0.930253565311432","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$16,500","$33,000","$17,250","$34,500","$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-00","Standard Silver Off Exchange Plan","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-01","Standard Silver On Exchange Plan","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","12","14002","TN","Individual","No","62-0427913","14002TN0330008","BlueCross Silver S12S","14002TN033",,"TNN001","TNS001","TNF009","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-03","Limited Cost Sharing Plan Variation","71.96%","0.719600379467011","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-04","73% AV Level Silver Plan","74.00%","0.73997163772583","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500","$4,500","$9,000","20%",,,,"$11,000","$22,000","$15,500","$31,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-05","87% AV Level Silver Plan","86.21%","0.862064838409424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100","$750","$1,500","20%",,,,"$11,000","$22,000","$11,750","$23,500","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330009","BlueCross Silver S14S","14002TN033",,"TNN001","TNS001","TNF011","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330009-06","94% AV Level Silver Plan","93.08%","0.930751979351044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","$1,700",,,"$19,050","$38,100","$19,900","$39,800","$0","$0","20%",,,,"$11,000","$22,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-01","Standard Silver On Exchange Plan","71.96%","0.719600379467011","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-03","Limited Cost Sharing Plan Variation","71.96%","0.719600379467011","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800","$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-04","73% AV Level Silver Plan","74.00%","0.73997163772583","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","$24,250","$48,500","$4,500","$9,000","20%",,,,"$11,000","$22,000","$15,500","$31,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-05","87% AV Level Silver Plan","86.21%","0.862064838409424","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$19,050","$38,100","$21,050","$42,100","$750","$1,500","20%",,,,"$11,000","$22,000","$11,750","$23,500","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","13","14002","TN","Individual","No","62-0427913","14002TN0330019","BlueCross Silver S14E","14002TN033",,"TNN003","TNS002","TNF011","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330019-06","94% AV Level Silver Plan","93.08%","0.930751979351044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","$1,700",,,"$19,050","$38,100","$19,900","$39,800","$0","$0","20%",,,,"$11,000","$22,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-00","Standard Silver Off Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-01","Standard Silver On Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-03","Limited Cost Sharing Plan Variation","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-04","73% AV Level Silver Plan","72.00%","0.720003962516785","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,950","$5,900",,,"$10,500","$21,000","$13,450","$26,900",,,,,,,,,,,,,,,,,,,,,"$2,950","$5,900","0%",,,,"$7,000","$14,000","$9,950","$19,900",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-05","87% AV Level Silver Plan","86.24%","0.862436950206757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,500","$21,000","$11,650","$23,300",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"$7,000","$14,000","$8,150","$16,300",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330010","BlueCross Silver S16S","14002TN033",,"TNN001","TNS001","TNF010","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330010-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,500","$21,000","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$7,000","$14,000","$7,500","$15,000",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340007","BlueCross Gold G10S","14002TN034",,"TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340007-03","Limited Cost Sharing Plan Variation","78.56%","0.78556501865387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340015","BlueCross Gold G10E","14002TN034",,"TNN003","TNS002","TNF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340015-01","Standard Gold On Exchange Plan","78.56%","0.78556501865387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350003","BlueCross Platinum P03S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350003-03","Limited Cost Sharing Plan Variation","88.26%","0.882617235183716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030001","Community Health Gold 1","66842TN003",,"TNN001","TNS001","TNF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/formulary/","66842TN0030001-01","Standard Gold On Exchange Plan","81.15%","0.814063489437103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","5"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040001","CHA 1","66842TN004",,"TNN001","TNS001","TNF002","New","EPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040001/","http://www.chatn.org/members/formulary/","66842TN0040001-01","Standard Platinum On Exchange Plan","88.52%","0.894707381725311","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$20","$700","$150","$250","$550","$120","$80","5"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030001","Community Health Gold 1","66842TN003",,"TNN001","TNS001","TNF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/formulary/","66842TN0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040002","CHA 2","66842TN004",,"TNN001","TNS001","TNF004","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040002/","http://www.chatn.org/members/formulary/","66842TN0040002-01","Standard Gold On Exchange Plan","80.75%","0.813973009586334","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","7"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030002","Community Health Gold 2","66842TN003",,"TNN001","TNS001","TNF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/formulary/","66842TN0030002-00","Standard Gold Off Exchange Plan","78.57%","0.76467353105545","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$1,000","$20","$1,880","$150","$1,000","$500","$320","$80","8"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030002","Community Health Gold 2","66842TN003",,"TNN001","TNS001","TNF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/formulary/","66842TN0030002-03","Limited Cost Sharing Plan Variation","78.57%","0.76467353105545","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$1,000","$20","$1,880","$150","$1,000","$500","$320","$80","11"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040005","CHA 4","66842TN004",,"TNN001","TNS001","TNF008","New","EPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040005/","http://www.chatn.org/members/formulary/","66842TN0040005-00","Standard Silver Off Exchange Plan","71.38%","0.671493530273438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","12"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-00","Standard Silver Off Exchange Plan","71.08%","0.668634295463562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","12"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040005","CHA 4","66842TN004",,"TNN001","TNS001","TNF008","New","EPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040005/","http://www.chatn.org/members/formulary/","66842TN0040005-01","Standard Silver On Exchange Plan","71.38%","0.671493530273438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","13"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-01","Standard Silver On Exchange Plan","71.08%","0.668634295463562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","13"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040006","CHA 5","66842TN004",,"TNN001","TNS001","TNF009","New","EPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040006/","http://www.chatn.org/members/formulary/","66842TN0040006-00","Standard Silver Off Exchange Plan","69.20%","0.65123724937439","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$2,100","$150","$2,000","$460","$370","$80","14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340015","BlueCross Gold G10E","14002TN034",,"TNN003","TNS002","TNF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","20","14002","TN","Individual","No","62-0427913","14002TN0340015","BlueCross Gold G10E","14002TN034",,"TNN003","TNS002","TNF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340015-03","Limited Cost Sharing Plan Variation","78.56%","0.78556501865387","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","14","14002","TN","Individual","No","62-0427913","14002TN0330020","BlueCross Silver S16E","14002TN033",,"TNN003","TNS002","TNF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0330020-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,500","$21,000","$11,000","$22,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$7,000","$14,000","$7,500","$15,000",,,,,,,,,"16"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340001","BlueCross Gold G01S","14002TN034",,"TNN001","TNS001","TNF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340001-00","Standard Gold Off Exchange Plan","78.05%","0.780546188354492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340001","BlueCross Gold G01S","14002TN034",,"TNN001","TNS001","TNF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340001-01","Standard Gold On Exchange Plan","78.05%","0.780546188354492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340001","BlueCross Gold G01S","14002TN034",,"TNN001","TNS001","TNF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340001","BlueCross Gold G01S","14002TN034",,"TNN001","TNS001","TNF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340001-03","Limited Cost Sharing Plan Variation","78.05%","0.780546188354492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340009","BlueCross Gold G01E","14002TN034",,"TNN003","TNS002","TNF006","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340009-01","Standard Gold On Exchange Plan","78.05%","0.780546188354492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340009","BlueCross Gold G01E","14002TN034",,"TNN003","TNS002","TNF006","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","15","14002","TN","Individual","No","62-0427913","14002TN0340009","BlueCross Gold G01E","14002TN034",,"TNN003","TNS002","TNF006","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340009-03","Limited Cost Sharing Plan Variation","78.05%","0.780546188354492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$15,750","$31,500","$21,000","$42,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","35%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010006","BEST Dental Basic - Silver","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Basic_Plan_(Silver).pdf",,"24601TN0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010006","BEST Dental Basic - Silver","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Basic_Plan_(Silver).pdf",,"24601TN0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","Individual","Yes","95-6042390","24601TN0020006","BESTOne Dental Basic - Silver","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"24601TN0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040001","CHA 1","66842TN004",,"TNN001","TNS001","TNF002","New","EPO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040001/","http://www.chatn.org/members/formulary/","66842TN0040001-00","Standard Platinum Off Exchange Plan","88.52%","0.894707381725311","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$20","$700","$150","$250","$550","$120","$80","4"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030001","Community Health Gold 1","66842TN003",,"TNN001","TNS001","TNF006","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030001/","http://www.chatn.org/members/formulary/","66842TN0030001-00","Standard Gold Off Exchange Plan","81.15%","0.814063489437103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,350","$150","$500","$580","$240","$80","4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340002","BlueCross Gold G02S","14002TN034",,"TNN001","TNS001","TNF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340002-00","Standard Gold Off Exchange Plan","81.78%","0.817800939083099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340002","BlueCross Gold G02S","14002TN034",,"TNN001","TNS001","TNF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340002-01","Standard Gold On Exchange Plan","81.78%","0.817800939083099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340002","BlueCross Gold G02S","14002TN034",,"TNN001","TNS001","TNF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340002","BlueCross Gold G02S","14002TN034",,"TNN001","TNS001","TNF008","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340002-03","Limited Cost Sharing Plan Variation","81.78%","0.817800939083099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340010","BlueCross Gold G02E","14002TN034",,"TNN003","TNS002","TNF008","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340010-01","Standard Gold On Exchange Plan","81.78%","0.817800939083099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340010","BlueCross Gold G02E","14002TN034",,"TNN003","TNS002","TNF008","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","16","14002","TN","Individual","No","62-0427913","14002TN0340010","BlueCross Gold G02E","14002TN034",,"TNN003","TNS002","TNF008","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340010-03","Limited Cost Sharing Plan Variation","81.78%","0.817800939083099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","17","14002","TN","Individual","No","62-0427913","14002TN0340003","BlueCross Gold G04S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340003-00","Standard Gold Off Exchange Plan","81.15%","0.811477065086365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","$16,000","$32,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340004","BlueCross Gold G06S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340004-00","Standard Gold Off Exchange Plan","79.10%","0.791000127792358","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340004","BlueCross Gold G06S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340004-01","Standard Gold On Exchange Plan","79.10%","0.791000127792358","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340004","BlueCross Gold G06S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340004","BlueCross Gold G06S","14002TN034",,"TNN001","TNS001","TNF012","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340004-03","Limited Cost Sharing Plan Variation","79.10%","0.791000127792358","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","18","14002","TN","Individual","No","62-0427913","14002TN0340012","BlueCross Gold G06E","14002TN034",,"TNN003","TNS002","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340012-01","Standard Gold On Exchange Plan","79.10%","0.791000127792358","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020006","myCigna Health Flex 1900","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020006-00","Standard Gold Off Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020006","myCigna Health Flex 1900","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020006-01","Standard Gold On Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020006","myCigna Health Flex 1900","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020006","myCigna Health Flex 1900","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020006-03","Limited Cost Sharing Plan Variation","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-00","Standard Silver Off Exchange Plan","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","Yes","59-1031071","99248TN0030002","myCigna Dental Family + Pediatric","99248TN003","7730182962","TNN001","TNS002",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"99248TN0030002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-01","Standard Silver On Exchange Plan","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-03","Limited Cost Sharing Plan Variation","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","3","99248","TN","Individual","No","59-1031071","99248TN0020002","myCigna Health Flex 5500","99248TN002","7730182962","TNN001","TNS001","TNF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020002-00","Standard Bronze Off Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600034-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"41"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340013","BlueCross Gold G08E","14002TN034",,"TNN003","TNS002","TNF010","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340013-01","Standard Gold On Exchange Plan","78.05%","0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340013","BlueCross Gold G08E","14002TN034",,"TNN003","TNS002","TNF010","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","19","14002","TN","Individual","No","62-0427913","14002TN0340013","BlueCross Gold G08E","14002TN034",,"TNN003","TNS002","TNF010","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0340013-03","Limited Cost Sharing Plan Variation","78.05%","0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"10"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","Individual","Yes","95-6042390","24601TN0020005","BESTOne Dental Plus - Silver","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"24601TN0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010005","BEST Dental Plus - Silver","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Plus_Plan_(Silver).pdf",,"24601TN0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","Individual","Yes","95-6042390","24601TN0020005","BESTOne Dental Plus - Silver","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"24601TN0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","Individual","Yes","95-6042390","24601TN0020006","BESTOne Dental Basic - Silver","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"24601TN0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040006","CHA 5","66842TN004",,"TNN001","TNS001","TNF009","New","EPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040006/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040006/","http://www.chatn.org/members/formulary/","66842TN0040006-01","Standard Silver On Exchange Plan","69.20%","0.65123724937439","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$2,100","$150","$2,000","$460","$370","$80","15"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-03","Limited Cost Sharing Plan Variation","71.08%","0.668634295463562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$420","$280","$80","15"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-04","73% AV Level Silver Plan","73.70%","0.68683534860611","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$20","$1,580","$150","$2,000","$390","$280","$80","16"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040007","CHA HDP 2","66842TN004",,"TNN001","TNS001","TNF014","New","EPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040007/","http://www.chatn.org/members/formulary/","66842TN0040007-00","Standard Silver Off Exchange Plan",,"0.709602534770966","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","$5,250","$10,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$0","$1,110","$150","$1,750","$0","$700","$80","16"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040007","CHA HDP 2","66842TN004",,"TNN001","TNS001","TNF014","New","EPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040007/","http://www.chatn.org/members/formulary/","66842TN0040007-01","Standard Silver On Exchange Plan",,"0.709602534770966","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","$5,250","$10,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$0","$1,110","$150","$1,750","$0","$700","$80","17"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-05","87% AV Level Silver Plan","87.30%","0.868683338165283","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$20","$1,400","$150","$250","$500","$240","$80","17"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040008","CHA 6","66842TN004",,"TNN001","TNS001","TNF012","New","EPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040008/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040008/","http://www.chatn.org/members/formulary/","66842TN0040008-00","Standard Bronze Off Exchange Plan","59.36%","0.598820626735687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","18"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350001","BlueCross Platinum P01S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350001-01","Standard Platinum On Exchange Plan","88.25%","0.882483839988709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350001","BlueCross Platinum P01S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350001","BlueCross Platinum P01S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350001-03","Limited Cost Sharing Plan Variation","88.25%","0.882483839988709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350004","BlueCross Platinum P01E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350004-01","Standard Platinum On Exchange Plan","88.25%","0.882483839988709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350004","BlueCross Platinum P01E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","22","14002","TN","Individual","No","62-0427913","14002TN0350004","BlueCross Platinum P01E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350004-03","Limited Cost Sharing Plan Variation","88.25%","0.882483839988709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$5,400","$10,800","$7,200","$14,400","$0","$0","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350002","BlueCross Platinum P02S","14002TN035",,"TNN001","TNS001","TNF008","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350002-00","Standard Platinum Off Exchange Plan","89.22%","0.892159700393677","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350002","BlueCross Platinum P02S","14002TN035",,"TNN001","TNS001","TNF008","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350002-01","Standard Platinum On Exchange Plan","89.22%","0.892159700393677","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350002","BlueCross Platinum P02S","14002TN035",,"TNN001","TNS001","TNF008","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350002","BlueCross Platinum P02S","14002TN035",,"TNN001","TNS001","TNF008","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350002-03","Limited Cost Sharing Plan Variation","89.22%","0.892159700393677","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040003","CHA 3","66842TN004",,"TNN001","TNS001","TNF004","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040003/","http://www.chatn.org/members/formulary/","66842TN0040003-00","Standard Gold Off Exchange Plan","79.47%","0.753525972366333","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","$1,250","$2,500","$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","8"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040003","CHA 3","66842TN004",,"TNN001","TNS001","TNF004","New","EPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040003/","http://www.chatn.org/members/formulary/","66842TN0040003-01","Standard Gold On Exchange Plan","79.47%","0.753525972366333","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","$1,250","$2,500","$1,250","$20","$1,200","$150","$1,250","$460","$220","$80","9"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030002","Community Health Gold 2","66842TN003",,"TNN001","TNS001","TNF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/formulary/","66842TN0030002-01","Standard Gold On Exchange Plan","78.57%","0.76467353105545","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$2,000","$1,000","$20","$1,880","$150","$1,000","$500","$320","$80","9"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030002","Community Health Gold 2","66842TN003",,"TNN001","TNS001","TNF005","New","EPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030002/","http://www.chatn.org/members/formulary/","66842TN0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040004","CHA HDP 1","66842TN004",,"TNN001","TNS001","TNF015","New","EPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040004/","http://www.chatn.org/members/formulary/","66842TN0040004-00","Standard Gold Off Exchange Plan",,"0.781938672065735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$0","$580","$150","$1,500","$50","$330","$80","10"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040004","CHA HDP 1","66842TN004",,"TNN001","TNS001","TNF015","New","EPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040004/","http://www.chatn.org/members/formulary/","66842TN0040004-01","Standard Gold On Exchange Plan",,"0.781938672065735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$0","$580","$150","$1,500","$50","$330","$80","11"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350005","BlueCross Platinum P02E","14002TN035",,"TNN003","TNS002","TNF008","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350005-01","Standard Platinum On Exchange Plan","89.22%","0.892159700393677","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","SHOP (Small Group)","No","45-3127905","66842TN0040008","CHA 6","66842TN004",,"TNN001","TNS001","TNF012","New","EPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842TN0040008/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842TN0040008/","http://www.chatn.org/members/formulary/","66842TN0040008-01","Standard Bronze On Exchange Plan","59.36%","0.598820626735687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$4,000","$0","$1,310","$150","$4,000","$30","$470","$80","19"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-01","Standard Silver On Exchange Plan","68.59%","0.622735142707825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$20","$1,130","$150","$3,500","$200","$160","$80","20"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-03","Limited Cost Sharing Plan Variation","68.59%","0.622735142707825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$20","$1,130","$150","$3,500","$200","$160","$80","22"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-04","73% AV Level Silver Plan","73.50%","0.656820118427277","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","30%",,,,"Not Applicable","Not Applicable","$2,750","$5,500","$2,750","$20","$1,350","$150","$2,750","$310","$190","$80","23"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-05","87% AV Level Silver Plan","86.10%","0.850465059280396","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$450","$900","20%",,,,"Not Applicable","Not Applicable","$450","$900","$450","$20","$1,360","$150","$450","$490","$240","$80","24"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-06","94% AV Level Silver Plan","93.20%","0.927065134048462","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%",,,,"Not Applicable","Not Applicable","$150","$300","$150","$10","$710","$150","$150","$210","$130","$80","25"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-00","Standard Silver Off Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$0","$0","$150","$3,500","$0","$0","$80","26"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-01","Standard Silver On Exchange Plan","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$0","$0","$150","$3,500","$0","$0","$80","27"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0040001","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.30",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0040001-00","Standard Low Off Exchange Plan","71.56%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0040002","Delta Dental Small Group Product","22384TN004",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$31.03",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,"https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0040002-00","Standard High Off Exchange Plan","84.33%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","Individual","Yes","62-0812197","22384TN0030002","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$32.21",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,,,,"22384TN0030002-00","Standard High Off Exchange Plan","83.01%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","2","22384","TN","Individual","Yes","62-0812197","22384TN0010003","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,,,,"22384TN0010003-01","Standard Low On Exchange Plan","70.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","2","22384","TN","Individual","Yes","62-0812197","22384TN0010004","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,,,,"22384TN0010004-01","Standard High On Exchange Plan","84.65%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","4","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0020003","Delta Dental FFM SHOP Product","22384TN002",,"TNN002","TNS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.45",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/SmallGroupMarketplace/Family",,,,"22384TN0020003-01","Standard Low On Exchange Plan","70.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","4","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0020004","Delta Dental FFM SHOP Product","22384TN002",,"TNN002","TNS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.76",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/SmallGroupMarketplace/Family",,,,"22384TN0020004-01","Standard High On Exchange Plan","84.65%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010001","BEST Life Child Dental Plus","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Child_Dental_Plus_Plan.pdf",,"24601TN0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","1","24601","TN","Individual","Yes","95-6042390","24601TN0020001","BESTOne Child Dental Plus","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Child_Dental_Plus_Plan.pdf",,"24601TN0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","1","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010001","BEST Life Child Dental Plus","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Child_Dental_Plus_Plan.pdf",,"24601TN0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","1","24601","TN","Individual","Yes","95-6042390","24601TN0020001","BESTOne Child Dental Plus","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Child_Dental_Plus_Plan.pdf",,"24601TN0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010002","BEST Life Child Dental","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Child_Dental_Plan.pdf",,"24601TN0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350005","BlueCross Platinum P02E","14002TN035",,"TNN003","TNS002","TNF008","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","23","14002","TN","Individual","No","62-0427913","14002TN0350005","BlueCross Platinum P02E","14002TN035",,"TNN003","TNS002","TNF008","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350005-03","Limited Cost Sharing Plan Variation","89.22%","0.892159700393677","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350003","BlueCross Platinum P03S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350003-00","Standard Platinum Off Exchange Plan","88.26%","0.882617235183716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350003","BlueCross Platinum P03S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350003-01","Standard Platinum On Exchange Plan","88.26%","0.882617235183716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350003","BlueCross Platinum P03S","14002TN035",,"TNN001","TNS001","TNF001","New","PPO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","TN","14002","HIOS","7","2014-01-29 08:00:05","24","14002","TN","Individual","No","62-0427913","14002TN0350006","BlueCross Platinum P03E","14002TN035",,"TNN003","TNS002","TNF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide","Yes","Out of State is BlueCard PPO, In State is Out of Network Benefits","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0350006-03","Limited Cost Sharing Plan Variation","88.26%","0.882617235183716","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000","$0","$0","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600014-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600015","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600015-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600015","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600015-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0010001","Guardian Pediatric Advantage","90402TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0010001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0020001","Guardian Pediatric Essentials","90402TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0020001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0020001","Guardian Pediatric Essentials","90402TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0020001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0030001","Guardian Family Advantage Plus","90402TN003",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0030001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","2","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0030001","Guardian Family Advantage Plus","90402TN003",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0030001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","3","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0050001","Guardian Family Essentials Plus","90402TN005",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0050001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","3","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0050001","Guardian Family Essentials Plus","90402TN005",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0050001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","4","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0040001","Guardian Family Advantage","90402TN004",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0040001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","4","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0040001","Guardian Family Advantage","90402TN004",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0040001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","4","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0060001","Guardian Family Essentials","90402TN006",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0060001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","4","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0060001","Guardian Family Essentials","90402TN006",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0060001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020001","myCigna Health Savings 6100","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020001-00","Standard Bronze Off Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","Yes","59-1031071","99248TN0030001","myCigna Dental Pediatric","99248TN003","7730182962","TNN001","TNS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"99248TN0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020001","myCigna Health Savings 6100","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020001-01","Standard Bronze On Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","Yes","59-1031071","99248TN0030001","myCigna Dental Pediatric","99248TN003","7730182962","TNN001","TNS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"99248TN0030001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","Individual","Yes","62-0812197","22384TN0010001","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$28.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0010001-01","Standard Low On Exchange Plan","70.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0020001","Delta Dental FFM SHOP Product","22384TN002",,"TNN002","TNS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.45",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/ACAMarketplace/SmallGroupPediatricPlan","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0020001-01","Standard Low On Exchange Plan","70.34%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","Individual","Yes","62-0812197","22384TN0010002","Delta Dental FFM Individual Product","22384TN001",,"TNN002","TNS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$35.41",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/ACAMarketplace/IndividualPediatricPlan","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0010002-01","Standard High On Exchange Plan","84.65%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","SHOP (Small Group)","Yes","62-0812197","22384TN0020002","Delta Dental FFM SHOP Product","22384TN002",,"TNN002","TNS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.76",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes","http://www.deltadentaltn.com/ACAMarketplace/SmallGroupPediatricPlan","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta",,,"22384TN0020002-01","Standard High On Exchange Plan","84.65%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","22384","HIOS","5","2014-01-22 07:31:14","1","22384","TN","Individual","Yes","62-0812197","22384TN0030001","Delta Dental Individual Plan","22384TN003",,"TNN002","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.32",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Benefits allowed as 'Non Participating'","Yes","Benefits allowed as Delta Dental PPO or Non Participating","Yes",,,,,"22384TN0030001-00","Standard Low Off Exchange Plan","70.41%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","2","24601","TN","Individual","Yes","95-6042390","24601TN0020002","BESTOne Child Dental","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Child_Dental_Plan.pdf",,"24601TN0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","2","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010002","BEST Life Child Dental","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Child_Dental_Plan.pdf",,"24601TN0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","2","24601","TN","Individual","Yes","95-6042390","24601TN0020002","BESTOne Child Dental","24601TN002",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.44",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Child_Dental_Plan.pdf",,"24601TN0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010003","BEST Dental Advantage - Gold","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Advantage_Plan_(Gold).pdf",,"24601TN0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","Individual","Yes","95-6042390","24601TN0020003","BESTOne Dental Advantage - Gold","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"24601TN0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","Individual","Yes","95-6042390","24601TN0020003","BESTOne Dental Advantage - Gold","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"24601TN0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010003","BEST Dental Advantage - Gold","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Advantage_Plan_(Gold).pdf",,"24601TN0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","Individual","Yes","95-6042390","24601TN0020004","BESTOne Dental Plus - Gold","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"24601TN0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010004","BEST Dental Plus - Gold","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Plus_Plan_(Gold).pdf",,"24601TN0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010004","BEST Dental Plus - Gold","24601TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Plus_Plan_(Gold).pdf",,"24601TN0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","3","24601","TN","Individual","Yes","95-6042390","24601TN0020004","BESTOne Dental Plus - Gold","24601TN002",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"24601TN0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TN","24601","HIOS","9","2014-01-21 08:29:49","4","24601","TN","SHOP (Small Group)","Yes","95-6042390","24601TN0010005","BEST Dental Plus - Silver","24601TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.55",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TN/pdf/TN_BEST_Dental_Plus_Plan_(Silver).pdf",,"24601TN0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030003","Community Health Silver 1","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030003/","http://www.chatn.org/members/formulary/","66842TN0030003-06","94% AV Level Silver Plan","94.00%","0.935030281543732","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$75","$150","10%",,,,"Not Applicable","Not Applicable","$75","$150","$70","$10","$720","$150","$80","$210","$1,300","$80","18"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030004","Community Health Silver 2","66842TN003",,"TNN001","TNS001","TNF010","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030004/","http://www.chatn.org/members/formulary/","66842TN0030004-00","Standard Silver Off Exchange Plan","68.59%","0.622735142707825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$20","$1,130","$150","$3,500","$200","$160","$80","19"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030005","Community Health Silver HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030005/","http://www.chatn.org/members/formulary/","66842TN0030005-03","Limited Cost Sharing Plan Variation","68.84%","0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","$3,500","$7,000","$3,500","$0","$0","$150","$3,500","$0","$0","$80","29"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030007","Community Health Bronze HDP 1","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030007/","http://www.chatn.org/members/formulary/","66842TN0030007-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","$6,250","$12,500",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","$6,250","$12,500","$6,250","$0","$0","$150","$5,270","$0","$0","$80","40"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030008","Community Health Value Plan","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030008/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030008/","http://www.chatn.org/members/formulary/","66842TN0030008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700","$6,350","$0","$0","$150","$5,270","$0","$0","$80","41"
"2014","TN","66842","HIOS","5","2013-10-15 07:27:56","1","66842","TN","Individual","No","45-3127905","66842TN0030008","Community Health Value Plan","66842TN003",,"TNN001","TNS001","TNF011","New","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.chatn.org/members/plans/66842tn0030008/","http://www.chatn.org/members/payments/","http://www.chatn.org/members/plans/66842tn0030008/","http://www.chatn.org/members/formulary/","66842TN0030008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700","$6,350","$0","$0","$150","$5,270","$0","$0","$80","42"
"2014","TN","77432","HIOS","2","2013-08-01 12:48:00","1","77432","TN","SHOP (Small Group)","Yes","35-0472300","77432TN0010001","DentalConnect�","77432TN001",,"TNN001","TNS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"77432TN0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","77432","HIOS","2","2013-08-01 12:48:00","1","77432","TN","SHOP (Small Group)","Yes","35-0472300","77432TN0010002","DentalConnect�","77432TN001",,"TNN001","TNS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"77432TN0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","3","99248","TN","Individual","No","59-1031071","99248TN0020002","myCigna Health Flex 5500","99248TN002","7730182962","TNN001","TNS001","TNF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020002-03","Limited Cost Sharing Plan Variation","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-00","Standard Silver Off Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-01","Standard Silver On Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-03","Limited Cost Sharing Plan Variation","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","3","26539","TX","Individual","No","75-2569094","26539TX0140004","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$151.77","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","3","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140004-01","Standard Bronze On Exchange Plan",,"0.61899346113205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$520","150","$5,000","$70","$0","80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130004","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF003","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","3","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130004-00","Standard Bronze Off Exchange Plan",,"0.61899346113205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$520","150","$5,000","$70","$0","80","4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020007","myCigna Health Flex 1250","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020007-01","Standard Gold On Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020007","myCigna Health Flex 1250","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","4","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0230001","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0230001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","4","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0230001","Guardian Family Advantage","12846TX023",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0230001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","4","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0250001","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0250001-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0010001","Managed DentalGuard TX Child Essentials 2","26250TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$9.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0010001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0010001","Managed DentalGuard TX Child Essentials 2","26250TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$9.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0010001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","2","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0030001","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0030001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","2","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0030001","Managed DentalGuard TX 10 Family Plan","26250TX003",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0030001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","2","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0040001","Managed DentalGuard TX 30 Family Plan","26250TX004",,"TXN001","TXS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"26250TX0040001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","2","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0050001","Managed DentalGuard TX 40 Family Plan","26250TX005",,"TXN001","TXS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"26250TX0050001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140001","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$75.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140001-01","Standard Gold On Exchange Plan",,"0.796359539031982","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$1,310","150","$0","$1,620",,"80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130001","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130001-00","Standard Gold Off Exchange Plan",,"0.796359539031982","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$1,310","150","$0","$1,620",,"80","4"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","3","24349","TX","Individual","Yes","94-2761537","24349TX0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","24349TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010004",,"24349TX0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","3","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020006",,"24349TX0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640030-00","Standard Platinum Off Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640030-01","Standard Platinum On Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","Yes","39-1263473","82120TN0630001","Humana Dental Smart Choice","82120TN063",,"TNN005","TNS005",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084394",,"82120TN0630001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600024-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600025","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600025-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600025","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600025-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600025","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600025-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-06","94% AV Level Silver Plan","94.30%","0.861155152320862","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600034-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-06","94% AV Level Silver Plan","93.40%","0.93491131067276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020007","myCigna Health Flex 1250","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020007-00","Standard Gold Off Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020007","myCigna Health Flex 1250","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020007-03","Limited Cost Sharing Plan Variation","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-04","73% AV Level Silver Plan","72.60%","0.742500603199005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-05","87% AV Level Silver Plan","86.30%","0.867777764797211","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","4","99248","TN","Individual","No","59-1031071","99248TN0020004","myCigna Health Flex 1500","99248TN002","7730182962","TNN001","TNS001","TNF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020004-06","94% AV Level Silver Plan","93.40%","0.935220003128052","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0200001","Guardian Pediatric Advantage","12846TX020",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0200001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0200001","Guardian Pediatric Advantage","12846TX020",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0200001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0210001","Guardian Pediatric Essentials","12846TX021",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0210001-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","1","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0210001","Guardian Pediatric Essentials","12846TX021",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0210001-01","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","3","24349","TX","Individual","Yes","94-2761537","24349TX0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","24349TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010004",,"24349TX0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","4","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020004",,"24349TX0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","3","99248","TN","Individual","No","59-1031071","99248TN0020002","myCigna Health Flex 5500","99248TN002","7730182962","TNN001","TNS001","TNF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020002-01","Standard Bronze On Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","3","99248","TN","Individual","No","59-1031071","99248TN0020002","myCigna Health Flex 5500","99248TN002","7730182962","TNN001","TNS001","TNF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600013","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN001","TNS001","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600013-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600014-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600014","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600014-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600015","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600015","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN001","TNS001","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600015-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600023","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN002","TNS002","TNF002","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600023-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600024-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600024-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600024","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600024-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600025","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN002","TNS002","TNF003","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600025-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"35"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,200","$50,400","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600033","Humana Local Preferred Silver 4600/6300 Plan","82120TN060",,"TNN003","TNS003","TNF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104934","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069925","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600033-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,200","$50,400","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$9,200","$18,400","Not Applicable","Not Applicable","$250","$500","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600034","Humana Local Preferred Gold 2500/3500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104947","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059577","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600034-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600035","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600035-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600035","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600035-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"44"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","1","82120","TN","Individual","No","39-1263473","82120TN0600035","Humana Local Preferred Platinum 1000/1500 Plan","82120TN060",,"TNN003","TNS003","TNF003","New","PPO","Platinum","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104960","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069938","http://apps.humana.com/marketing/documents.asp?file=2067403","82120TN0600035-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600011","Humana Local Preferred Basic 6350/6350 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104908","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059460","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600011-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600011","Humana Local Preferred Basic 6350/6350 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104908","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059460","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600012-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140001","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$75.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0",,,,"5"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0220001","Guardian Family Advantage Plus","12846TX022",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0220001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","2","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0220001","Guardian Family Advantage Plus","12846TX022",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0220001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","3","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0240001","Guardian Family Essentials Plus","12846TX024",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0240001-00","Standard Low Off Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","3","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0240001","Guardian Family Essentials Plus","12846TX024",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0240001-01","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","12846","HIOS","5","2013-09-12 11:27:35","4","12846","TX","SHOP (Small Group)","Yes","13-5123390","12846TX0250001","Guardian Family Essentials","12846TX025",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"12846TX0250001-01","Standard Low On Exchange Plan","69.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","1","19312","TX","Individual","Yes","91-1857813","19312TX0010001","Smile for Kids (EHB) - PPO","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$25.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0010001-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","1","19312","TX","SHOP (Small Group)","Yes","91-1857813","19312TX0020001","Smile for Kids (EHB) - PPO","19312TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$22.47",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0020001-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","1","19312","TX","SHOP (Small Group)","Yes","91-1857813","19312TX0020001","Smile for Kids (EHB) - PPO","19312TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$22.47",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0020001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","1","19312","TX","Individual","Yes","91-1857813","19312TX0010001","Smile for Kids (EHB) - PPO","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$25.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0010001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","2","19312","TX","Individual","Yes","91-1857813","19312TX0010003","PLUS Family with EHB","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0010003-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","2","19312","TX","SHOP (Small Group)","Yes","91-1857813","19312TX0020003","PLUS Family with EHB","19312TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$22.47",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0020003-00","Standard Low Off Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","2","19312","TX","Individual","Yes","91-1857813","19312TX0010003","PLUS Family with EHB","19312TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$25.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0010003-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","19312","HIOS","5","2013-09-22 09:35:26","2","19312","TX","SHOP (Small Group)","Yes","91-1857813","19312TX0020003","PLUS Family with EHB","19312TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Adult and Child-Only",,,,"$22.47",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule agreed to by participating providers.","Yes","www.premierlife.com/txhealthreform",,"www.premierlife.com/txhealthreform",,"19312TX0020003-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420002","Blue Choice Gold PPO 002","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental 2A","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500005-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470001","Blue Advantage Gold HMO 001","33602TX047",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470001-00","Standard Gold Off Exchange Plan","79.28%","0.792829096317291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600005","BlueCare Dental 1C","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600005-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130003","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130003-01","Standard Silver On Exchange Plan",,"0.692722201347351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$890","150","$0","$1,660","$0","80","5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-04","73% AV Level Silver Plan",,"0.73196816444397","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$60","$890","150","$0","$1,660","$0","80","7"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-05","87% AV Level Silver Plan",,"0.87788188457489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$30","$890","150","$0","$550","$0","80","8"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-06","94% AV Level Silver Plan",,"0.948374688625336","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$450","150","$0","$250","$0","80","9"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600012-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130001","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130001-01","Standard Gold On Exchange Plan",,"0.796359539031982","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$1,310","150","$0","$1,620",,"80","5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130002","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"5","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130002-00","Standard Gold Off Exchange Plan",,"0.78076159954071","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,850","$0","150","$0","$1,620",,"80","6"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-03","Limited Cost Sharing Plan Variation",,"0.692722201347351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$890","150","$0","$1,660","$0","80","6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640018-03","Limited Cost Sharing Plan Variation","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460005","Blue Advantage Bronze HMO 005","33602TX046",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460005","Blue Advantage Bronze HMO 005","33602TX046",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460005-03","Limited Cost Sharing Plan Variation",,"0.598176956176758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020001",,"23749TX0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","Individual","Yes","75-1233841","23749TX0010001","Dentegra Dental PPO Children's Plan 70","23749TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010001",,"23749TX0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020001",,"23749TX0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","Individual","Yes","75-1233841","23749TX0010001","Dentegra Dental PPO Children's Plan 70","23749TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010001",,"23749TX0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","Individual","Yes","75-1233841","23749TX0010002","Dentegra Dental PPO Children's Plan 85","23749TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010002",,"23749TX0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020002","Dentegra Dental PPO Children's Plan 85","23749TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020002",,"23749TX0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020002","Dentegra Dental PPO Children's Plan 85","23749TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020002",,"23749TX0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","1","23749","TX","Individual","Yes","75-1233841","23749TX0010002","Dentegra Dental PPO Children's Plan 85","23749TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010002",,"23749TX0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","2","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020006",,"23749TX0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600012","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN001","TNS001","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600012-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600021","Humana Local Preferred Basic 6350/6350 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104908","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059460","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600021-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600021","Humana Local Preferred Basic 6350/6350 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104908","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059460","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600022-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600022-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600022","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN002","TNS002","TNF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600022-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600031","Humana Local Preferred Basic 6350/6350 Plan","82120TN060",,"TNN003","TNS003","TNF001","New","PPO","Catastrophic","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104908","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059460","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600031-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN003","TNS003","TNF001","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600032-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN003","TNS003","TNF001","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","TN","82120","HIOS","9","2014-01-21 08:29:49","2","82120","TN","Individual","No","39-1263473","82120TN0600032","Humana Local Preferred Bronze 6300/6300 Plan","82120TN060",,"TNN003","TNS003","TNF001","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2104921","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059486","http://apps.humana.com/marketing/documents.asp?file=2067338","82120TN0600032-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","TN","90402","HIOS","3","2013-09-02 11:39:25","1","90402","TN","SHOP (Small Group)","Yes","13-5123390","90402TN0010001","Guardian Pediatric Advantage","90402TN001",,"TNN001","TNS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"90402TN0010001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020001","myCigna Health Savings 6100","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020001","myCigna Health Savings 6100","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020001-03","Limited Cost Sharing Plan Variation","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-00","Standard Silver Off Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-01","Standard Silver On Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-03","Limited Cost Sharing Plan Variation","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-04","73% AV Level Silver Plan","73.20%","0.684354066848755","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","1","99248","TN","Individual","No","59-1031071","99248TN0020003","myCigna Health Savings 3400","99248TN002","7730182962","TNN001","TNS001","TNF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020003-05","87% AV Level Silver Plan","86.60%","0.812985122203827","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-04","73% AV Level Silver Plan","72.00%","0.714676856994629","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TN","99248","HIOS","14","2013-10-15 07:27:56","2","99248","TN","Individual","No","59-1031071","99248TN0020005","myCigna Health Flex 5000","99248TN002","7730182962","TNN001","TNS001","TNF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services except exclusions listed in Benefits Package.","Yes","Some services excluded. See plan documents.","Yes","http://www.cigna.com/individuals-families/plans/tennessee-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/tennessee-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","99248TN0020005-05","87% AV Level Silver Plan","86.20%","0.866659820079803","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","4","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020004",,"24349TX0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0020001","Managed DentalGuard TX Child Essentials 1","26250TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0020001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","26250","HIOS","5","2013-09-17 16:07:07","1","26250","TX","SHOP (Small Group)","Yes","75-2698702","26250TX0020001","Managed DentalGuard TX Child Essentials 1","26250TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.27",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"26250TX0020001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020002",,"24349TX0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","Individual","Yes","94-2761537","24349TX0010002","Delta Dental PPO Plan 85 for Children","24349TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010002",,"24349TX0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","Individual","Yes","94-2761537","24349TX0010002","Delta Dental PPO Plan 85 for Children","24349TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010002",,"24349TX0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020002",,"24349TX0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","2","24349","TX","Individual","Yes","94-2761537","24349TX0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","24349TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010006",,"24349TX0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","2","24349","TX","Individual","Yes","94-2761537","24349TX0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","24349TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010006",,"24349TX0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640030","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640030-03","Limited Cost Sharing Plan Variation","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600002","BlueCare Dental 1B","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO 003","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600006","BlueCare Dental 1D","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600006-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420010","Blue Security Choice PPO 010","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420010","Blue Security Choice PPO 010","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460001","Blue Advantage Gold HMO 001","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460001-00","Standard Gold Off Exchange Plan","79.28%","0.792829096317291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600005","BlueCare Dental 1C","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600005-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","2","23749","TX","Individual","Yes","75-1233841","23749TX0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","23749TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010006",,"23749TX0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","2","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020006",,"23749TX0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","2","23749","TX","Individual","Yes","75-1233841","23749TX0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","23749TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.68",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010006",,"23749TX0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","3","23749","TX","Individual","Yes","75-1233841","23749TX0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","23749TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010004",,"23749TX0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","3","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020004",,"23749TX0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","3","23749","TX","SHOP (Small Group)","Yes","75-1233841","23749TX0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","23749TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.81",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"dentegra.com/hx/tx/23749tx0020004",,"23749TX0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23749","HIOS","7","2014-01-17 09:36:20","3","23749","TX","Individual","Yes","75-1233841","23749TX0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","23749TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/tx/23749tx0010004",,"23749TX0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","Individual","Yes","74-2447512","23891TX0010001","DeltaCare USA Plan 70 for Children","23891TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010001",,"23891TX0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020001","DeltaCare USA Plan 70 for Children for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020001",,"23891TX0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","Individual","Yes","74-2447512","23891TX0010001","DeltaCare USA Plan 70 for Children","23891TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010001",,"23891TX0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020001","DeltaCare USA Plan 70 for Children for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020001",,"23891TX0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","Individual","Yes","74-2447512","23891TX0010002","DeltaCare USA Plan 85 for Children","23891TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010002",,"23891TX0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020002","DeltaCare USA Plan 85 for Children for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020002",,"23891TX0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020002","DeltaCare USA Plan 85 for Children for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020002",,"23891TX0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","1","23891","TX","Individual","Yes","74-2447512","23891TX0010002","DeltaCare USA Plan 85 for Children","23891TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010002",,"23891TX0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","2","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020006",,"23891TX0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","2","23891","TX","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Plan 70 for Children + Basic for Adults","23891TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010006",,"23891TX0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","2","23891","TX","Individual","Yes","74-2447512","23891TX0010006","DeltaCare USA Plan 70 for Children + Basic for Adults","23891TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010006",,"23891TX0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","2","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020006","DeltaCare USA Plan 70 for Children + Basic for Adults for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020006",,"23891TX0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","3","23891","TX","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Plan 85 for Children + Preferred for Adults","23891TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010004",,"23891TX0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","3","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020004",,"23891TX0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","3","23891","TX","Individual","Yes","74-2447512","23891TX0010004","DeltaCare USA Plan 85 for Children + Preferred for Adults","23891TX001",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/23891tx0010004",,"23891TX0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","23891","HIOS","8","2014-03-19 07:06:49","3","23891","TX","SHOP (Small Group)","Yes","74-2447512","23891TX0020004","DeltaCare USA Plan 85 for Children + Preferred for Adults for Small Businesses","23891TX002",,"TXN001","TXS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,"deltadentalins.com/hx/tx/23891tx0020004",,"23891TX0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","Individual","Yes","94-2761537","24349TX0010001","Delta Dental PPO Plan 70 for Children","24349TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010001",,"24349TX0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020001",,"24349TX0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020001",,"24349TX0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","1","24349","TX","Individual","Yes","94-2761537","24349TX0010001","Delta Dental PPO Plan 70 for Children","24349TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/tx/24349tx0010001",,"24349TX0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","24349","HIOS","7","2014-01-21 08:29:49","3","24349","TX","SHOP (Small Group)","Yes","94-2761537","24349TX0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","24349TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.22",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,,"deltadentalins.com/hx/tx/24349tx0020006",,"24349TX0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140001","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$75.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140001-03","Limited Cost Sharing Plan Variation",,"0.796359539031982","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$1,310","150","$0","$1,620",,"80","6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640015-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-00","Standard Silver Off Exchange Plan","70.66%","0.707258582115173","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-01","Standard Silver On Exchange Plan","70.66%","0.707258582115173","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-03","Limited Cost Sharing Plan Variation","70.66%","0.707258582115173","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-04","73% AV Level Silver Plan","73.05%","0.730464696884155","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-05","87% AV Level Silver Plan","86.57%","0.86570155620575","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460004","Blue Advantage Silver HMO 004","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460004-06","94% AV Level Silver Plan","94.17%","0.941670835018158","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460005","Blue Advantage Bronze HMO 005","33602TX046",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460005-00","Standard Bronze Off Exchange Plan",,"0.598176956176758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470005","Blue Advantage Bronze HMO 005","33602TX047",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470005-00","Standard Bronze Off Exchange Plan",,"0.598176956176758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470005","Blue Advantage Bronze HMO 005","33602TX047",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470005-01","Standard Bronze On Exchange Plan",,"0.598176956176758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640038-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Direct Platinum 0/1500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060006","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630006-00","Standard Platinum Off Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420005","Blue Choice Bronze PPO 005","33602TX042",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO 006","33602TX043",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600004","BlueCare Dental 4 Kids 1B","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids 1B","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430028","Blue Choice Silver PPO 028","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430028-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470021","Blue Advantage Silver HMO 021","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470021-00","Standard Silver Off Exchange Plan","70.60%","0.706023275852203","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","10","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470021","Blue Advantage Silver HMO 021","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470021-01","Standard Silver On Exchange Plan","70.60%","0.706023275852203","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470020","Blue Advantage Silver HMO 020","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470020-00","Standard Silver Off Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","11","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470020","Blue Advantage Silver HMO 020","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470020-01","Standard Silver On Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0030001","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140002","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$81.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"5","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140002-01","Standard Gold On Exchange Plan",,"0.78076159954071","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,850","$0","150","$0","$1,620",,"80","7"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130002","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"5","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130002-01","Standard Gold On Exchange Plan",,"0.78076159954071","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,850","$0","150","$0","$1,620",,"80","7"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140002","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$81.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"5","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0",,,,"8"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","1","26539","TX","Individual","No","75-2569094","26539TX0140002","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$81.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"5","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140002-03","Limited Cost Sharing Plan Variation",,"0.78076159954071","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,850","$0","150","$0","$1,620",,"80","9"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130003","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130003-00","Standard Silver Off Exchange Plan",,"0.692722201347351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$890","150","$0","$1,660","$0","80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","2","26539","TX","Individual","No","75-2569094","26539TX0140003","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$118.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140003-01","Standard Silver On Exchange Plan",,"0.692722201347351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$70","$890","150","$0","$1,660","$0","80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","3","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130004","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF003","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","3","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130004-01","Standard Bronze On Exchange Plan",,"0.61899346113205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$520","150","$5,000","$70","$0","80","5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","3","26539","TX","Individual","No","75-2569094","26539TX0140004","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$151.77","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","3","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","3","26539","TX","Individual","No","75-2569094","26539TX0140004","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF003","New","HMO","Bronze","No","On the Exchange","No","No",,,"$151.77","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","3","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140004-03","Limited Cost Sharing Plan Variation",,"0.61899346113205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$520","150","$5,000","$70","$0","80","6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN002","TXS001","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN002","TXS001","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640015-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640017-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640017-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"35"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640017","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640017-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600006","BlueCare Dental 1D","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600006-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420002","Blue Choice Gold PPO 002","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","4","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130005","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130005-00","Standard Bronze Off Exchange Plan",,"0.591230452060699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$0","$1,100","150","$4,500","$0","$310","80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","4","26539","TX","Individual","No","75-2569094","26539TX0140005","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$161.94","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140005-01","Standard Bronze On Exchange Plan",,"0.591230452060699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$0","$1,100","150","$4,500","$0","$310","80","4"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","4","26539","TX","Individual","No","75-2569094","26539TX0140005","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$161.94","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","4","26539","TX","SHOP (Small Group)","No","75-2569094","26539TX0130005","FirstCare Health Plans","26539TX013",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0130005-01","Standard Bronze On Exchange Plan",,"0.591230452060699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$0","$1,100","150","$4,500","$0","$310","80","5"
"2014","TX","26539","HIOS","5","2013-11-25 12:40:15","4","26539","TX","Individual","No","75-2569094","26539TX0140005","FirstCare Health Plans","26539TX014",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$161.94","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"0.93",,,"0","0","0","2014-01-01",,"Yes","Covered for emergency care.  See Plan documents for details on how to access care.","Yes","Covered for emergency care and urgent care.  See Plan documents for details on how to access care.","Yes","https://firstcare.softheon.com/sbc","https://FirstCare.softheon.com/payment","http://www.firstcare.com/marketplace","www.firstcare.com/marketplace","26539TX0140005-03","Limited Cost Sharing Plan Variation",,"0.591230452060699","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$0","$1,100","150","$4,500","$0","$310","80","6"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Care Gold","27248TX001","7932102164","TXN001","TXS001","TXF003","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Gold.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Gold.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010001-01","Standard Gold On Exchange Plan",,"0.806196808815002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$960","$0","$150","$0","$1,690","$0","$80","4"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Care Gold","27248TX001","7932102164","TXN001","TXS001","TXF003","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Gold.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Gold.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010001","Community Care Gold","27248TX001","7932102164","TXN001","TXS001","TXF003","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Gold.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Gold.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010001-03","Limited Cost Sharing Plan Variation",,"0.806196808815002","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$960","$0","$150","$0","$1,690","$0","$80","6"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-01","Standard Silver On Exchange Plan",,"0.715426087379456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$1,320","$0","$150","$0","$2,420","$0","$80","7"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-03","Limited Cost Sharing Plan Variation",,"0.715426087379456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$1,320","$0","$150","$0","$2,420","$0","$80","9"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-04","73% AV Level Silver Plan",,"0.737031638622284","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$1,190","$0","$150","$0","$2,170","$0","$80","10"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-05","87% AV Level Silver Plan",,"0.87338000535965","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$800","$0","$150","$0","$1,350","$0","$80","11"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","1","27248","TX","Individual","No","76-0495152","27248TX0010002","Community Care Silver","27248TX001","7932102164","TXN001","TXS001","TXF002","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Silver.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Silver.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010002-06","94% AV Level Silver Plan",,"0.935057818889618","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$620","$0","$150","$0","$800","$0","$80","12"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Care Bronze","27248TX001","7932102164","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Bronze.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Bronze.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010003-01","Standard Bronze On Exchange Plan",,"0.616425216197968","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$2,500","$5,000","0%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,500","$970","$0","$150","$2,500","$1,290","$0","$80","4"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Care Bronze","27248TX001","7932102164","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Bronze.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Bronze.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","27248","HIOS","7","2013-09-10 14:43:20","2","27248","TX","Individual","No","76-0495152","27248TX0010003","Community Care Bronze","27248TX001","7932102164","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","No",,"Yes","For urgent/emergent care circumstances only","No","https://www.CHCHealth.org/AffordableHealth/BenefitsandCoverage/Bronze.aspx",,"https://www.CHCHealth.org/AffordableHealth/PlanBrochure/Bronze.aspx","https://www.CHCHealth.org/AffordableHealth/DrugFormulary.aspx","27248TX0010003-03","Limited Cost Sharing Plan Variation",,"0.616425216197968","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$2,500","$5,000","0%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,500","$970","$0","$150","$2,500","$1,290","$0","$80","6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630004","Humana Direct Silver 4600/6300 Plan","32673TX063",,"TXN001","TXS003","TXF003","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105012","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060188","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Direct Gold 2500/3500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105025","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059954","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Direct Gold 2500/3500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105025","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059954","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Direct Gold 2500/3500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105025","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059954","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0630005","Humana Direct Gold 2500/3500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105025","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059954","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640018-00","Standard Platinum Off Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640018","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN004","TXS002","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640018-01","Standard Platinum On Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","2","33348","TX","Individual","Yes","72-0977315","33348TX0020002","AlwaysCare AllStar Family Dental Plan","33348TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0020002-00","Standard Low Off Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","2","33348","TX","Individual","Yes","72-0977315","33348TX0020002","AlwaysCare AllStar Family Dental Plan","33348TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0020002-01","Standard Low On Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640004","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN002","TXS001","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640001","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020009","myCigna Health Flex 1900","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020009-00","Standard Gold Off Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020009","myCigna Health Flex 1900","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020009-01","Standard Gold On Exchange Plan","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","Yes","36-1236610","33602TX0500004","BlueCare Dental 4 Kids 1B","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600004","BlueCare Dental 4 Kids 1B","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420006","Blue Choice Bronze PPO 006","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420006","Blue Choice Bronze PPO 006","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-01","Standard Silver On Exchange Plan","71.10%","0.708941876888275","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","40%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","40%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$470","$1,790","$150","$0","$1,640","$510","$80","4"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-03","Limited Cost Sharing Plan Variation","71.10%","0.708941876888275","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","40%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","40%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$470","$1,790","$150","$0","$1,640","$510","$80","6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN003","TXS004","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640027-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN003","TXS004","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640027-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN005","TXS005","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640039-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN005","TXS005","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN005","TXS005","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640039-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","1","33348","TX","Individual","Yes","72-0977315","33348TX0010001","AlwaysCare AllStar Kids Dental Plan","33348TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0010001-00","Standard High Off Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO 005","33602TX043",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-01","Standard Silver On Exchange Plan","70.73%","0.707263290882111","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-03","Limited Cost Sharing Plan Variation","70.73%","0.707263290882111","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-04","73% AV Level Silver Plan","73.52%","0.735160112380981","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-05","87% AV Level Silver Plan","87.59%","0.875936031341553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN003","TXS004","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640027","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN003","TXS004","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640027-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640039","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN005","TXS005","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640039-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640005","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640016","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN004","TXS002","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640016-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640028","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN003","TXS004","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640028-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640029-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640029-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"46"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640029","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN003","TXS004","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640029-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"50"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"52"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"53"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640040","Humana Connect Silver 4600/6300 Plan","32673TX064",,"TXN005","TXS005","TXF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105090","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069808","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640040-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640041-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640041-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640041-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"57"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","1","32673","TX","Individual","No","61-0994632","32673TX0640041","Humana Connect Gold 2500/3500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105116","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2090738","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640041-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"58"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630001","Humana Direct Basic 6350/6350 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104973","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059915","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630001","Humana Direct Basic 6350/6350 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104973","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059915","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Direct Bronze 6300/6300 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104986","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059863","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Direct Bronze 6300/6300 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104986","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059863","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Direct Bronze 6300/6300 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104986","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059863","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0630002","Humana Direct Bronze 6300/6300 Plan","32673TX063",,"TXN001","TXS003","TXF001","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104986","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059863","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0630002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640001","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640002","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN002","TXS001","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640013","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640013","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640014-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640014-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640014","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN004","TXS002","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640014-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640025","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640025","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640026-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640026-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430027","Blue Choice Silver PPO 027","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430027-01","Standard Silver On Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","9","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430028","Blue Choice Silver PPO 028","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430028-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0010001","Delta Dental Individual PPO, EHB Certified","40540TX001",,"TXN002","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0010002","Delta Dental Individual PPO, EHB Certified","40540TX001",,"TXN002","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0030002","Renaissance Group Dental PPO, EHB Certified","40540TX003",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640026","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN003","TXS004","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640026-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640037","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640037-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640037","Humana Connect Basic 6350/6350 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Catastrophic","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105051","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069743","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640037-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640038-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640038-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","2","32673","TX","Individual","No","61-0994632","32673TX0640038","Humana Connect Bronze 6300/6300 Plan","32673TX064",,"TXN005","TXS005","TXF001","New","HMO","Bronze","No","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105064","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069717","http://apps.humana.com/marketing/documents.asp?file=2067364","32673TX0640038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Direct Platinum 0/1500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060006","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630006-01","Standard Platinum On Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Direct Platinum 0/1500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060006","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0630006","Humana Direct Platinum 0/1500 Plan","32673TX063",,"TXN001","TXS003","TXF004","New","HMO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2060006","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630006-03","Limited Cost Sharing Plan Variation","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640006-00","Standard Platinum Off Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640006-01","Standard Platinum On Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640006","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN002","TXS001","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640006-03","Limited Cost Sharing Plan Variation","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640042-00","Standard Platinum Off Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640042-01","Standard Platinum On Exchange Plan","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640042-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","3","32673","TX","Individual","No","61-0994632","32673TX0640042","Humana Connect Platinum 0/1500 Plan","32673TX064",,"TXN005","TXS005","TXF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105129","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069795","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640042-03","Limited Cost Sharing Plan Variation","90.23%","0.90232241153717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Direct Bronze 4850/6350 Plan","32673TX063",,"TXN001","TXS003","TXF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104999","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059889","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Direct Bronze 4850/6350 Plan","32673TX063",,"TXN001","TXS003","TXF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104999","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059889","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Direct Bronze 4850/6350 Plan","32673TX063",,"TXN001","TXS003","TXF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104999","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059889","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0630003","Humana Direct Bronze 4850/6350 Plan","32673TX063",,"TXN001","TXS003","TXF002","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104999","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059889","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0630003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN002","TXS001","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640003","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN002","TXS001","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","32673","HIOS","6","2013-08-30 07:44:10","4","32673","TX","Individual","No","61-0994632","32673TX0640015","Humana Connect Bronze 4850/6350 Plan","32673TX064",,"TXN004","TXS002","TXF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999825",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105077","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2069730","http://apps.humana.com/marketing/documents.asp?file=2067429","32673TX0640015-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460005","Blue Advantage Bronze HMO 005","33602TX046",,"TXN002","TXS002","TXF008","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460005-01","Standard Bronze On Exchange Plan",,"0.598176956176758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO 006","33602TX047",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470006-00","Standard Bronze Off Exchange Plan",,"0.597155630588531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470006","Blue Advantage Bronze HMO 006","33602TX047",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470006-01","Standard Bronze On Exchange Plan",,"0.597155630588531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO 006","33602TX046",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460006-00","Standard Bronze Off Exchange Plan",,"0.597155630588531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","1","33348","TX","Individual","Yes","72-0977315","33348TX0010001","AlwaysCare AllStar Kids Dental Plan","33348TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0010001-01","Standard High On Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600003","BlueCare Dental 4 Kids 1A","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420005","Blue Choice Bronze PPO 005","33602TX042",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400 H.S.A.","40788TX019",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400 H.S.A.","40788TX019",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-03","Limited Cost Sharing Plan Variation","78.80%","0.761456727981567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-05","87% AV Level Silver Plan",,"0.878215670585632","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","55%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-06","94% AV Level Silver Plan",,"0.934350728988647","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-05","87% AV Level Silver Plan","87.60%","0.876001060009003","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$50","$500","$1,250","$700","$200","$350","$1,250","8"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-06","94% AV Level Silver Plan","94.88%","0.948848783969879","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$15","$734","$1,000","$200","$50","$450","$1,000","9"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010002","CommunityFirst Premier","46224TX001",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010002-01","Standard Gold On Exchange Plan","79.22%","0.792152762413025","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$50","$906","$3,000","$1,500","$200","$480","$3,000","10"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010002","CommunityFirst Premier","46224TX001",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,"$0","$0","$0",,"$0","$0","$0","11"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","1","33348","TX","Individual","Yes","72-0977315","33348TX0010002","AlwaysCare AllStar Kids Dental Plan","33348TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0010002-00","Standard Low Off Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","1","33348","TX","Individual","Yes","72-0977315","33348TX0010002","AlwaysCare AllStar Kids Dental Plan","33348TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.52",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0010002-01","Standard Low On Exchange Plan","71.81%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","2","33348","TX","Individual","Yes","72-0977315","33348TX0020001","AlwaysCare AllStar Family Dental Plan","33348TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0020001-00","Standard High Off Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33348","HIOS","4","2014-01-21 08:29:49","2","33348","TX","Individual","Yes","72-0977315","33348TX0020001","AlwaysCare AllStar Family Dental Plan","33348TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"The adult plan has a $50 deductible and a $1000 annual maximum.",,,,,"Allows Adult and Child-Only",,,,"$47.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes"," Any Claim submitted for procedures performed outside the U.S.A. must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes"," Any Claim submitted for procedures performed outside the service area must: (1) be for a Covered Procedure, as defined; (2) be supplied in English; (3) use American Dental Association (ADA) codes; and (4) be in U.S. Dollar currency.  Reimbursement will be based on the Maximum Allowable Charge, Participating Provider Maximum Allowable Charge, or applicable Scheduled Fee amounts for the Insured’s zip code.","Yes",,,"www.alwayscarebenefits.com/allstar",,"33348TX0020001-01","Standard High On Exchange Plan","83.48%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$15","Not Applicable",,,,,"$15","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600001","BlueCare Dental 1A","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental 1A","33602TX050",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420001","Blue Choice Gold PPO 001","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO 001","33602TX043",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600001","BlueCare Dental 1A","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420001","Blue Choice Gold PPO 001","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500001","BlueCare Dental 1A","33602TX050",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430001","Blue Choice Gold PPO 001","33602TX043",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600002","BlueCare Dental 1B","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420001","Blue Choice Gold PPO 001","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430002","Blue Choice Gold PPO 002","33602TX043",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental 1B","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420001","Blue Choice Gold PPO 001","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430003","Blue Choice Silver PPO 003","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500002","BlueCare Dental 1B","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430004","Blue Choice Silver PPO 004","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430004-00","Standard Silver Off Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","Yes","36-1236610","33602TX0500005","BlueCare Dental 2A","33602TX050",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500005-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600008","BlueCare Dental 1G","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600008-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420002","Blue Choice Gold PPO 002","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430004","Blue Choice Silver PPO 004","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430004-01","Standard Silver On Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600008","BlueCare Dental 1G","33602TX060",,"TXN004","TXS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600008-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420002","Blue Choice Gold PPO 002","33602TX042",,"TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420003","Blue Choice Silver PPO 003","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","1","33602","TX","Individual","No","36-1236610","33602TX0420004","Blue Choice Silver PPO 004","33602TX042",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420005","Blue Choice Bronze PPO 005","33602TX042",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids 1A","33602TX050",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430005","Blue Choice Bronze PPO 005","33602TX043",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","Yes","36-1236610","33602TX0500003","BlueCare Dental 4 Kids 1A","33602TX050",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbstx.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbstx.com/coverage/individual/on-exchange/dental/",,"33602TX0500003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600003","BlueCare Dental 4 Kids 1A","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420005","Blue Choice Bronze PPO 005","33602TX042",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430006","Blue Choice Bronze PPO 006","33602TX043",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420006","Blue Choice Bronze PPO 006","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","2","33602","TX","Individual","No","36-1236610","33602TX0420006","Blue Choice Bronze PPO 006","33602TX042",,"TXN001","TXS001","TXF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0420006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470001","Blue Advantage Gold HMO 001","33602TX047",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470001-01","Standard Gold On Exchange Plan","79.28%","0.792829096317291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460001","Blue Advantage Gold HMO 001","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460001-01","Standard Gold On Exchange Plan","79.28%","0.792829096317291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","2","40540","TX","Individual","Yes","47-0397286","40540TX0070001","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_Ped_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","www.renaissancedental.com/TX_EHB_Plan_Brochure",,"40540TX0070001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","2","40540","TX","Individual","Yes","47-0397286","40540TX0070002","Renaissance Individual Dental Pediatric-Only, EHB Certified (Exchange)","40540TX007",,"TXN001","TXS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$28.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_Ped_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","www.renaissancedental.com/TX_EHB_Plan_Brochure",,"40540TX0070002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","1","40788","TX","Individual","No","74-2052197","40788TX0160001","Scott and White Health Plan Catastrophic 6350","40788TX016",,"TXN001","TXS001","TXF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","3","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0160001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-01","Standard Silver On Exchange Plan","68.10%","0.677092254161835","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-03","Limited Cost Sharing Plan Variation","68.10%","0.677092254161835","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-04","73% AV Level Silver Plan","72.20%","0.710581660270691","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-05","87% AV Level Silver Plan","87.40%","0.860200107097626","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0180001","Scott and White Health Plan Silver 3000","40788TX018",,"TXN001","TXS001","TXF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180001-06","94% AV Level Silver Plan","93.30%","0.897824168205261","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-01","Standard Gold On Exchange Plan","78.40%","0.770116329193115","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020001","myCigna Health Savings 6100","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020001-00","Standard Bronze Off Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","Yes","59-1031071","55409TX0030001","myCigna Dental Pediatric","55409TX003","7730182962","TXN001","TXS003",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"55409TX0030001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","Yes","59-1031071","55409TX0030001","myCigna Dental Pediatric","55409TX003","7730182962","TXN001","TXS003",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"55409TX0030001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020001","myCigna Health Savings 6100","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020001-01","Standard Bronze On Exchange Plan","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020001","myCigna Health Savings 6100","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600007","BlueCare Dental 1E","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.14",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600007-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460001","Blue Advantage Gold HMO 001","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470002","Blue Advantage Gold HMO 002","33602TX047",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470002-01","Standard Gold On Exchange Plan","79.69%","0.796903312206268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460001","Blue Advantage Gold HMO 001","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460001-03","Limited Cost Sharing Plan Variation","79.28%","0.792829096317291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","Yes","36-1236610","33602TX0600007","BlueCare Dental 1E","33602TX060",,"TXN004","TXS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$59.14",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbstx.com/employer/products/on-exchange/dental/",,"33602TX0600007-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO 003","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470003-00","Standard Silver Off Exchange Plan","70.73%","0.707263290882111","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470003","Blue Advantage Silver HMO 003","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470003-01","Standard Silver On Exchange Plan","70.73%","0.707263290882111","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460002","Blue Advantage Gold HMO 002","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460002-00","Standard Gold Off Exchange Plan","79.69%","0.796903312206268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460002","Blue Advantage Gold HMO 002","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460002-01","Standard Gold On Exchange Plan","79.69%","0.796903312206268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO 004","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470004-00","Standard Silver Off Exchange Plan","70.73%","0.707258582115173","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0470004","Blue Advantage Silver HMO 004","33602TX047",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0470004-01","Standard Silver On Exchange Plan","70.73%","0.707258582115173","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460002","Blue Advantage Gold HMO 002","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460002","Blue Advantage Gold HMO 002","33602TX046",,"TXN002","TXS002","TXF005","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460002-03","Limited Cost Sharing Plan Variation","79.69%","0.796903312206268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","3","33602","TX","Individual","No","36-1236610","33602TX0460003","Blue Advantage Silver HMO 003","33602TX046",,"TXN002","TXS002","TXF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460003-00","Standard Silver Off Exchange Plan","70.73%","0.707263290882111","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO 006","33602TX046",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460006-01","Standard Bronze On Exchange Plan",,"0.597155630588531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO 006","33602TX046",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","4","33602","TX","Individual","No","36-1236610","33602TX0460006","Blue Advantage Bronze HMO 006","33602TX046",,"TXN002","TXS002","TXF007","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0460006-03","Limited Cost Sharing Plan Variation",,"0.597155630588531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","33602","HIOS","8","2013-11-23 14:44:18","8","33602","TX","SHOP (Small Group)","No","36-1236610","33602TX0430027","Blue Choice Silver PPO 027","33602TX043",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are “Participating Providers”) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (“Host Blue”). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/employer/products/on-exchange/",,"http://www.bcbstx.com/employer/products/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0430027-00","Standard Silver Off Exchange Plan","71.56%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-01","Standard Silver On Exchange Plan",,"0.711166620254517","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-03","Limited Cost Sharing Plan Variation",,"0.711166620254517","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","4","40788","TX","Individual","No","74-2052197","40788TX0180002","Scott and White Health Plan Silver HMO 50","40788TX018",,"TXN001","TXS001","TXF005","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180002-04","73% AV Level Silver Plan",,"0.734242856502533","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080001","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_EHB_Group_High",,"www.renaissancedental.com/TX_EHB_Group_High",,"40540TX0080001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0020001","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0020002","Renaissance Individual Dental PPO, EHB Certified","40540TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080002","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_EHB_Group_Low",,"www.renaissancedental.com/TX_EHB_Group_Low",,"40540TX0080002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080003","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_50_50_High",,"www.renaissancedental.com/TX_50_50_High",,"40540TX0080003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0060001","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_EHB_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","www.renaissancedental.com/TX_EHB_Plan_Brochure",,"40540TX0060001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","Individual","Yes","47-0397286","40540TX0060002","Renaissance Individual Dental PPO, EHB Certified (Exchange)","40540TX006",,"TXN001","TXS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_EHB_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/40540","www.renaissancedental.com/TX_EHB_Plan_Brochure",,"40540TX0060002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","1","40540","TX","SHOP (Small Group)","Yes","47-0397286","40540TX0080004","Renaissance Group Dental PPO, EHB Certified (Exchange)","40540TX008",,"TXN001","TXS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.renaissancedental.com/TX_50_50_Low",,"www.renaissancedental.com/TX_50_50_Low",,"40540TX0080004-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","2","40540","TX","Individual","Yes","47-0397286","40540TX0050001","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$29.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0050001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","40540","HIOS","6","2013-11-26 13:14:08","2","40540","TX","Individual","Yes","47-0397286","40540TX0050002","Renaissance Individual Dental Pediatric-Only, EHB Certified","40540TX005",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"40540TX0050002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020001","myCigna Health Savings 6100","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-6100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020001-03","Limited Cost Sharing Plan Variation","58.20%","0.580140948295593","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,100","$12,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-00","Standard Silver Off Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-01","Standard Silver On Exchange Plan","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-03","Limited Cost Sharing Plan Variation","68.40%","0.631544411182404","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,400","$6,800","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-04","73% AV Level Silver Plan","73.20%","0.684354066848755","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-05","87% AV Level Silver Plan","86.60%","0.812985122203827","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020004","myCigna Health Savings 3400","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-savings-3400","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020004-06","94% AV Level Silver Plan","94.30%","0.861155152320862","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","2","40788","TX","Individual","No","74-2052197","40788TX0190001","Scott and White Health Plan Gold 1000","40788TX019",,"TXN001","TXS001","TXF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190001-03","Limited Cost Sharing Plan Variation","78.40%","0.770116329193115","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-04","73% AV Level Silver Plan","73.90%","0.736371397972107","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$0","$0","35%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","35%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$440","$1,570","$150","$0","$1,590","$450","$80","7"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-05","87% AV Level Silver Plan","87.80%","0.877585172653198","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$680","$320","$80","8"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","2","45786","TX","Individual","No","20-1494502","45786TX0010002","Molina Marketplace Silver Plan","45786TX001",,"TXN001","TXS001","TXF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9914",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/silver","45786TX0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-01","Standard Silver On Exchange Plan","68.52%","0.685167670249939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$60","$808","$6,000","$3,500","$260","$240","$6,000","4"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-03","Limited Cost Sharing Plan Variation","68.52%","0.685167670249939","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$60","$808","$6,000","$3,500","$260","$240","$6,000","6"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010001","CommunityFirstPlus","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Silver","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010001-04","73% AV Level Silver Plan","73.27%","0.732713282108307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$60","$908","$4,000","$3,000","$240","$340","$4,000","7"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","1","46224","TX","Individual","No","74-2723334","46224TX0010002","CommunityFirst Premier","46224TX001",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010002-03","Limited Cost Sharing Plan Variation","79.22%","0.792152762413025","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$50","$906","$3,000","$1,500","$200","$480","$3,000","12"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","2","46224","TX","Individual","No","74-2723334","46224TX0010003","CommunityFirst Value","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010003-01","Standard Bronze On Exchange Plan","61.83%","0.61825168132782","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,250","$10,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,250","$0","$916","$6,350","$5,250","$0","$1,150","$6,350","4"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","2","46224","TX","Individual","No","74-2723334","46224TX0010003","CommunityFirst Value","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-01","Standard Silver On Exchange Plan","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010002","BEST Life Child Dental","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Child_Dental_Plan.pdf",,"47665TX0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010003","BEST Dental Advantage - Gold","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47665TX0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","Individual","Yes","95-6042390","47665TX0020003","BESTOne Dental Advantage - Gold","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47665TX0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010003","BEST Dental Advantage - Gold","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47665TX0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","Individual","Yes","95-6042390","47665TX0020003","BESTOne Dental Advantage - Gold","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47665TX0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","Individual","Yes","95-6042390","47665TX0020004","BESTOne Dental Plus - Gold","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47665TX0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5000 H.S.A.","40788TX017",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-01","Standard Bronze On Exchange Plan","59.50%","0.591570556163788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5000 H.S.A.","40788TX017",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","48364","HIOS","7","2013-10-15 07:27:56","1","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)*","48364TX003",,"TXN003","TXS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056",,"48364TX0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","48364","HIOS","7","2013-10-15 07:27:56","1","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0030001","Family Basic Dental Plan (Low)*","48364TX003",,"TXN003","TXS001",,"New","HMO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$10.18",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48057",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48056",,"48364TX0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-05","87% AV Level Silver Plan","86.70%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$1,200","$2,400","$1,200","$2,400","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-06","94% AV Level Silver Plan","93.60%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020017","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020017-00","Standard Gold Off Exchange Plan","79.50%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020017","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020017-01","Standard Gold On Exchange Plan","79.50%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020017","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"13"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020017","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020017-03","Limited Cost Sharing Plan Variation","79.50%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","Individual","Yes","20-2970185","58609TX0010001","DentaQuest Dental Plan Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020001","DentaQuest Dental Plan Pediatric High","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","Individual","Yes","20-2970185","58609TX0010001","DentaQuest Dental Plan Pediatric High","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0170002","Scott and White Health Plan Bronze 5000 H.S.A.","40788TX017",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170002-03","Limited Cost Sharing Plan Variation","59.50%","0.591570556163788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-01","Standard Silver On Exchange Plan","68.70%","0.64389032125473","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","2","55409","TX","Individual","No","59-1031071","55409TX0020002","myCigna Health Flex 5500","55409TX002","7730182962","TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020002-03","Limited Cost Sharing Plan Variation","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","3","55409","TX","Individual","No","59-1031071","55409TX0020003","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS001","TXF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020003-00","Standard Bronze Off Exchange Plan","62.00%","0.633748888969421","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-03","Limited Cost Sharing Plan Variation","68.70%","0.64389032125473","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-04","73% AV Level Silver Plan","73.50%","0.728263378143311","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-05","87% AV Level Silver Plan","86.70%","0.857962965965271","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$550","$1,100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0180003","Scott and White Health Plan Silver 2750 H.S.A.","40788TX018",,"TXN001","TXS001","TXF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0180003-06","94% AV Level Silver Plan","94.40%","0.931664168834686","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","3","40788","TX","Individual","No","74-2052197","40788TX0190002","Scott and White Health Plan Gold 1400 H.S.A.","40788TX019",,"TXN001","TXS001","TXF008","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0190002-01","Standard Gold On Exchange Plan","78.80%","0.761456727981567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000","40788TX017",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","3","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-01","Standard Bronze On Exchange Plan",,"0.591246604919434","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000","40788TX017",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","3","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","40788","HIOS","6","2014-01-21 08:29:49","5","40788","TX","Individual","No","74-2052197","40788TX0170001","Scott and White Health Plan Bronze 6000","40788TX017",,"TXN001","TXS001","TXF002","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","3","2014-01-01",,"Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","Yes","For emergency care only. You must return to the Scott & White Health Plan service area and access network providers for non-emergency care to be covered.","No","https://swhp.org/plandoc",,"https://swhp.org/plandoc","https://swhp.org/members/manage-your-plan/exchange-members-pharmacy-information","40788TX0170001-03","Limited Cost Sharing Plan Variation",,"0.591246604919434","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","45786TX0010001-01","Standard Gold On Exchange Plan","79.60%","0.793061792850494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$380","$890","$150","$0","$1,140","$250","$80","4"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","45786TX0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","45786","HIOS","6","2013-10-15 07:27:56","1","45786","TX","Individual","No","20-1494502","45786TX0010001","Molina Marketplace Gold Plan","45786TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.998",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/tx/en-us/hp/marketplace/plans/gold","45786TX0010001-03","Limited Cost Sharing Plan Variation","79.60%","0.793061792850494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$380","$890","$150","$0","$1,140","$250","$80","6"
"2014","TX","46224","HIOS","9","2014-01-17 09:36:20","2","46224","TX","Individual","No","74-2723334","46224TX0010003","CommunityFirst Value","46224TX001",,"TXN001","TXS001","TXF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,"Refer to plan's certificate of coverage.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.cfhp.com/SBCs/HealthInsuranceExchange.asp","https://cfhp.softheon.com/marketplace/paymentcenter/payment.aspx","http://www.cfhp.com/members/documents/CFHP-Exchange-Benefit-Designs_100113.pdf","http://www.cfhp.com/members/commercial/ffmpreferreddrugs.pdf","46224TX0010003-03","Limited Cost Sharing Plan Variation","61.83%","0.61825168132782","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,250","$10,500","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,250","$0","$916","$6,350","$5,250","$0","$1,150","$6,350","6"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010001","BEST Life Child Dental Plus","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Child_Dental_Plus_Plan.pdf",,"47665TX0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","1","47665","TX","Individual","Yes","95-6042390","47665TX0020001","BESTOne Child Dental Plus","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Child_Dental_Plus_Plan.pdf",,"47665TX0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","1","47665","TX","Individual","Yes","95-6042390","47665TX0020001","BESTOne Child Dental Plus","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Child_Dental_Plus_Plan.pdf",,"47665TX0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","1","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010001","BEST Life Child Dental Plus","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Child_Dental_Plus_Plan.pdf",,"47665TX0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","2","47665","TX","Individual","Yes","95-6042390","47665TX0020002","BESTOne Child Dental","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Child_Dental_Plan.pdf",,"47665TX0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","2","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010002","BEST Life Child Dental","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Child_Dental_Plan.pdf",,"47665TX0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","2","47665","TX","Individual","Yes","95-6042390","47665TX0020002","BESTOne Child Dental","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Child_Dental_Plan.pdf",,"47665TX0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-00","Standard Silver Off Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-01","Standard Silver On Exchange Plan","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-03","Limited Cost Sharing Plan Variation","68.60%","0.693712592124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-04","73% AV Level Silver Plan","72.50%","0.73218709230423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$5,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-05","87% AV Level Silver Plan","86.00%","0.865245342254639","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,400","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020006","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020006-06","94% AV Level Silver Plan","93.10%","0.933359861373901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-00","Standard Silver Off Exchange Plan","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010004","BEST Dental Plus - Gold","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Plus_Plan_(Gold).pdf",,"47665TX0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","Individual","Yes","95-6042390","47665TX0020004","BESTOne Dental Plus - Gold","47665TX002",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47665TX0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","3","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010004","BEST Dental Plus - Gold","47665TX001",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Plus_Plan_(Gold).pdf",,"47665TX0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010005","BEST Dental Plus - Silver","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Plus_Plan_(Silver).pdf",,"47665TX0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","Individual","Yes","95-6042390","47665TX0020005","BESTOne Dental Plus - Silver","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"47665TX0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","Individual","Yes","95-6042390","47665TX0020005","BESTOne Dental Plus - Silver","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"47665TX0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010005","BEST Dental Plus - Silver","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Plus_Plan_(Silver).pdf",,"47665TX0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","Individual","Yes","95-6042390","47665TX0020006","BESTOne Dental Basic - Silver","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47665TX0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-05","87% AV Level Silver Plan","86.10%","0.861149072647095","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$1,400","$2,800","$1,400","$2,800","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-06","94% AV Level Silver Plan","93.00%","0.930801033973694","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$575","$1,150","$575","$1,150","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%","$200","$400","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-00","Standard Silver Off Exchange Plan","69.00%","0.684896290302277","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%","$5,000","$10,000","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-01","Standard Silver On Exchange Plan","69.00%","0.684896290302277","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%","$5,000","$10,000","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"13"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-03","Limited Cost Sharing Plan Variation","69.00%","0.684896290302277","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%","$5,000","$10,000","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-04","73% AV Level Silver Plan","72.00%","0.709948420524597","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","0%","$4,250","$8,500","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-05","87% AV Level Silver Plan","86.00%","0.845179319381714","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$1,450","$2,900","$1,450","$2,900","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","0%","$1,450","$2,900","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020014","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020014-06","94% AV Level Silver Plan","94.20%","0.93372905254364","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%","$600","$1,200","0%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020016","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020016-00","Standard Gold Off Exchange Plan","80.10%","0.80662989616394","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%","$1,250","$2,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020016","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020016-01","Standard Gold On Exchange Plan","80.10%","0.80662989616394","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%","$1,250","$2,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020016","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020016-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"20"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010006","BEST Dental Basic - Silver","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Basic_Plan_(Silver).pdf",,"47665TX0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","SHOP (Small Group)","Yes","95-6042390","47665TX0010006","BEST Dental Basic - Silver","47665TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BEST_Dental_Basic_Plan_(Silver).pdf",,"47665TX0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","47665","HIOS","7","2014-01-21 08:29:49","4","47665","TX","Individual","Yes","95-6042390","47665TX0020006","BESTOne Dental Basic - Silver","47665TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/TX/pdf/TX_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47665TX0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","48364","HIOS","7","2013-10-15 07:27:56","2","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN004","TXS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$12.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127",,"48364TX0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","48364","HIOS","7","2013-10-15 07:27:56","2","48364","TX","SHOP (Small Group)","Yes","75-2046497","48364TX0040001","Family Enhanced Dental Plan (High)","48364TX004",,"TXN004","TXS001",,"New","HMO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$12.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country claims are only covered for emergency treatment only. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","Out of country claims are only covered for emergency treatment only with a reimbursement of $50 USD.","No","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49128",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49127",,"48364TX0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-06","94% AV Level Silver Plan","93.80%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020011","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020011-00","Standard Gold Off Exchange Plan","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020011","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020011-01","Standard Gold On Exchange Plan","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020011","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020011","myCigna Copay Assure Gold","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-gold","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020011-03","Limited Cost Sharing Plan Variation","79.30%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","7","55409","TX","Individual","No","59-1031071","55409TX0020012","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS002","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020012-00","Standard Bronze Off Exchange Plan","62.00%","0.652479767799377","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%","$5,100","$10,200","40%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","7","55409","TX","Individual","No","59-1031071","55409TX0020012","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS002","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020012-01","Standard Bronze On Exchange Plan","62.00%","0.652479767799377","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%","$5,100","$10,200","40%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","7","55409","TX","Individual","No","59-1031071","55409TX0020012","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS002","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","7","55409","TX","Individual","No","59-1031071","55409TX0020012","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS002","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020012-03","Limited Cost Sharing Plan Variation","62.00%","0.652479767799377","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%","$5,100","$10,200","40%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-00","Standard Silver Off Exchange Plan","68.00%","0.688126385211945","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%","$2,750","$5,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020009","myCigna Health Flex 1900","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","1","55409","TX","Individual","No","59-1031071","55409TX0020009","myCigna Health Flex 1900","55409TX002","7730182962","TXN001","TXS001","TXF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1900","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020009-03","Limited Cost Sharing Plan Variation","78.60%","0.706511735916138","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,900","$4,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","2","55409","TX","Individual","Yes","59-1031071","55409TX0030002","myCigna Dental Family + Pediatric","55409TX003","7730182962","TXN001","TXS003",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","All Services","Yes",,,,,"55409TX0030002-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","2","55409","TX","Individual","No","59-1031071","55409TX0020002","myCigna Health Flex 5500","55409TX002","7730182962","TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020002-00","Standard Bronze Off Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","2","55409","TX","Individual","No","59-1031071","55409TX0020002","myCigna Health Flex 5500","55409TX002","7730182962","TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020002-01","Standard Bronze On Exchange Plan","60.30%","0.639346301555634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","2","55409","TX","Individual","No","59-1031071","55409TX0020002","myCigna Health Flex 5500","55409TX002","7730182962","TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","3","55409","TX","Individual","No","59-1031071","55409TX0020003","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS001","TXF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020003-01","Standard Bronze On Exchange Plan","62.00%","0.633748888969421","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","3","55409","TX","Individual","No","59-1031071","55409TX0020003","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS001","TXF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","3","55409","TX","Individual","No","59-1031071","55409TX0020003","myCigna Health Flex 5100","55409TX002","7730182962","TXN001","TXS001","TXF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All Services","Yes","All Services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020003-03","Limited Cost Sharing Plan Variation","62.00%","0.633748888969421","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,100","$10,200","40%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-00","Standard Silver Off Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-01","Standard Silver On Exchange Plan","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-03","Limited Cost Sharing Plan Variation","69.10%","0.709242641925812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-04","73% AV Level Silver Plan","72.50%","0.742465913295746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-05","87% AV Level Silver Plan","86.30%","0.867775917053223","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","4","55409","TX","Individual","No","59-1031071","55409TX0020005","myCigna Health Flex 1500","55409TX002","7730182962","TXN001","TXS001","TXF004","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1500","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020005-06","94% AV Level Silver Plan","93.40%","0.93521922826767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$575","$1,150",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-03","Limited Cost Sharing Plan Variation","69.40%","0.689291656017303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-04","73% AV Level Silver Plan","72.00%","0.714676856994629","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-05","87% AV Level Silver Plan","86.20%","0.866659820079803","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020007","myCigna Health Flex 5000","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-5000","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020007-06","94% AV Level Silver Plan","93.40%","0.93491131067276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020010","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020010-00","Standard Gold Off Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020010","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020010-01","Standard Gold On Exchange Plan","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020010","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","5","55409","TX","Individual","No","59-1031071","55409TX0020010","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS001","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020010-03","Limited Cost Sharing Plan Variation","80.60%","0.811365246772766","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-00","Standard Silver Off Exchange Plan","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-01","Standard Silver On Exchange Plan","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-03","Limited Cost Sharing Plan Variation","71.70%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-04","73% AV Level Silver Plan","73.80%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","6","55409","TX","Individual","No","59-1031071","55409TX0020008","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS001","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020008-05","87% AV Level Silver Plan","87.00%","0","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-01","Standard Silver On Exchange Plan","68.00%","0.688126385211945","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%","$2,750","$5,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-03","Limited Cost Sharing Plan Variation","68.00%","0.688126385211945","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%","$2,750","$5,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020013","myCigna Health Flex 2750","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-2750","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020013-04","73% AV Level Silver Plan","72.10%","0.727067232131958","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%","$2,250","$4,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","8","55409","TX","Individual","No","59-1031071","55409TX0020016","myCigna Health Flex 1250","55409TX002","7730182962","TXN001","TXS002","TXF005","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-health-flex-1250","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020016-03","Limited Cost Sharing Plan Variation","80.10%","0.80662989616394","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$2,500","$5,000","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%","$1,250","$2,500","20%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-00","Standard Silver Off Exchange Plan","71.20%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-01","Standard Silver On Exchange Plan","71.20%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-03","Limited Cost Sharing Plan Variation","71.20%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","55409","HIOS","12","2013-10-15 07:27:56","9","55409","TX","Individual","No","59-1031071","55409TX0020015","myCigna Copay Assure Silver","55409TX002","7730182962","TXN001","TXS002","TXF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","All services","Yes","All services","Yes","http://www.cigna.com/individuals-families/plans/texas-copay-assure-silver","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.cigna.com/individuals-families/plans/texas-local-plus-plan-comparison","www.cigna.com/ifp-drug-list","55409TX0020015-04","73% AV Level Silver Plan","73.40%","0","Yes","Yes","Yes","35%","65%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$25,000","$50,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","30%","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020001","DentaQuest Dental Plan Pediatric High","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020002","DentaQuest Dental Plan Pediatric Low","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","Individual","Yes","20-2970185","58609TX0010002","DentaQuest Dental Plan Pediatric Low","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","Individual","Yes","20-2970185","58609TX0010002","DentaQuest Dental Plan Pediatric Low","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","1","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020002","DentaQuest Dental Plan Pediatric Low","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest Dental Plan Family High","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","Individual","Yes","20-2970185","58609TX0010003","DentaQuest Dental Plan Family High","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","Individual","Yes","20-2970185","58609TX0010003","DentaQuest Dental Plan Family High","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.51",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020003","DentaQuest Dental Plan Family High","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.87",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","Individual","Yes","20-2970185","58609TX0010004","DentaQuest Dental Plan Family Low","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest Dental Plan Family Low","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","Individual","Yes","20-2970185","58609TX0010004","DentaQuest Dental Plan Family Low","58609TX001","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0010004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","58609","HIOS","3","2013-08-30 07:44:10","2","58609","TX","SHOP (Small Group)","Yes","20-2970185","58609TX0020004","DentaQuest Dental Plan Family Low","58609TX002","7083617218","TXN001","TXS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","Dentaquest.com/marketplace/tx","https://paydirect.dentaquest.com","Dentaquest.com/marketplace/tx",,"58609TX0020004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","60141","HIOS","5","2013-09-11 07:49:18","1","60141","TX","SHOP (Small Group)","Yes","74-2489037","60141TX0020001","Smile for Health Child 0-19 DHMO","60141TX002",,"TXN001","TXS001",,"New","HMO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No",,,,,"60141TX0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","60141","HIOS","5","2013-09-11 07:49:18","2","60141","TX","SHOP (Small Group)","Yes","74-2489037","60141TX0010001","Smile for Health Child DHMO","60141TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-dhmo.pdf",,,,"60141TX0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Direct Bronze 6300/6300 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105155","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058290","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TX","60141","HIOS","5","2013-09-11 07:49:18","2","60141","TX","SHOP (Small Group)","Yes","74-2489037","60141TX0010001","Smile for Health Child DHMO","60141TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-dhmo.pdf",,,,"60141TX0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","60141","HIOS","5","2013-09-11 07:49:18","2","60141","TX","SHOP (Small Group)","Yes","74-2489037","60141TX0010002","Smile for Health Family DHMO","60141TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-dhmo.pdf",,,,"60141TX0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","3","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Direct Bronze 4850/6350 Plan","63141TX074",,"TXN001","TXS001","TXF002","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105168","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058316","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","3","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Direct Bronze 4850/6350 Plan","63141TX074",,"TXN001","TXS001","TXF002","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105168","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058316","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020002","Ambetter Gold 2 + Vision","87226TX002",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010003","IdealCare Essential","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/bronze","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/bronze","www.senderohealth.com/idealcareformulary/","71837tx0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010003","IdealCare Essential","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/bronze","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/bronze","www.senderohealth.com/idealcareformulary/","71837tx0010003-03","Limited Cost Sharing Plan Variation",,"0.608645975589752","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$1,500","$540","$140","$190","$1,270","$450","$30","$220","15"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010012","Ambetter Bronze 3","87226TX001",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010013","Ambetter Bronze 4","87226TX001",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010013","Ambetter Bronze 4","87226TX001",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010013","Ambetter Bronze 4","87226TX001",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020002","Ambetter Gold 2 + Vision","87226TX002",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020002","Ambetter Gold 2 + Vision","87226TX002",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740006","Humana Direct Platinum 1000/1500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105207","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059798","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740006","Humana Direct Platinum 1000/1500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105207","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059798","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740006-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010010","Ambetter Bronze 1","87226TX001",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Direct Bronze 6300/6300 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105155","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058290","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Direct Bronze 6300/6300 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105155","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058290","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740002","Humana Direct Bronze 6300/6300 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105155","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058290","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020004","Ambetter Gold 4 + Vision","87226TX002",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","60141","HIOS","5","2013-09-11 07:49:18","2","60141","TX","SHOP (Small Group)","Yes","74-2489037","60141TX0010002","Smile for Health Family DHMO","60141TX001",,"TXN001","TXS001",,"New","HMO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$19.54",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-dhmo.pdf",,,,"60141TX0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","Yes","39-1263473","63141TX0760001","Humana Dental Smart Choice","63141TX076",,"TXN002","TXS002",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084459",,"63141TX0760001-01","Standard Low On Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740004","Humana Direct Silver 4600/6300 Plan","63141TX074",,"TXN001","TXS001","TXF003","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105181","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059824","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Direct Gold 2500/3500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105194","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058368","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Direct Gold 2500/3500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105194","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058368","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Direct Gold 2500/3500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105194","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058368","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740005","Humana Direct Gold 2500/3500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105194","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058368","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740006","Humana Direct Platinum 1000/1500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105207","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059798","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740006-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","1","63141","TX","Individual","No","39-1263473","63141TX0740006","Humana Direct Platinum 1000/1500 Plan","63141TX074",,"TXN001","TXS001","TXF004","New","EPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105207","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059798","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740006-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740001","Humana Direct Basic 6350/6350 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105142","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058355","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","2","63141","TX","Individual","No","39-1263473","63141TX0740001","Humana Direct Basic 6350/6350 Plan","63141TX074",,"TXN001","TXS001","TXF001","New","EPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105142","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058355","http://apps.humana.com/marketing/documents.asp?file=2067364","63141TX0740001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","3","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Direct Bronze 4850/6350 Plan","63141TX074",,"TXN001","TXS001","TXF002","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105168","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058316","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","63141","HIOS","8","2014-03-19 07:06:49","3","63141","TX","Individual","No","39-1263473","63141TX0740003","Humana Direct Bronze 4850/6350 Plan","63141TX074",,"TXN001","TXS001","TXF002","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services.","No","http://apps.humana.com/marketing/documents.asp?file=2105168","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058316","http://apps.humana.com/marketing/documents.asp?file=2067429","63141TX0740003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010009","Ambetter Silver 5","87226TX001",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010004","Ambetter Gold 4","87226TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010004","Ambetter Gold 4","87226TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010004","Ambetter Gold 4","87226TX001",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010010","Ambetter Bronze 1","87226TX001",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010010","Ambetter Bronze 1","87226TX001",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010012","Ambetter Bronze 3","87226TX001",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","2","87226","TX","Individual","No","74-2770542","87226TX0010012","Ambetter Bronze 3","87226TX001",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","3","87226","TX","Individual","No","74-2770542","87226TX0010008","Ambetter Silver 4","87226TX001",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020005","Ambetter Silver 1 + Vision","87226TX002",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020004","Ambetter Gold 4 + Vision","87226TX002",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020010","Ambetter Bronze 1 + Vision","87226TX002",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020010","Ambetter Bronze 1 + Vision","87226TX002",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020010","Ambetter Bronze 1 + Vision","87226TX002",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020012","Ambetter Bronze 3 + Vision","87226TX002",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020012","Ambetter Bronze 3 + Vision","87226TX002",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010007","Ambetter Silver 3","87226TX001",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-01","Standard Silver On Exchange Plan",,"0.682791352272034","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$750","$270","$140","$190","$1,270","$300","$30","$220","4"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020007","Ambetter Silver 3 + Vision","87226TX002",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","4","87226","TX","Individual","No","74-2770542","87226TX0020009","Ambetter Silver 5 + Vision","87226TX002",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020004","Ambetter Gold 4 + Vision","87226TX002",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-03","Limited Cost Sharing Plan Variation",,"0.682791352272034","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$750","$270","$140","$190","$1,270","$300","$30","$220","6"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-04","73% AV Level Silver Plan",,"0.739716649055481","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","15%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$600","$220","$110","$190","$1,270","$300","$20","$220","7"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-05","87% AV Level Silver Plan",,"0.87958824634552","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"Not Applicable","Not Applicable","$1,300","$2,600",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","$500","$1,000","$450","$170","$70","$190","$500","$300","$90","$220","8"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010001","IdealCare Complete","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Silver","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/silver","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/silver","www.senderohealth.com/idealcareformulary/","71837tx0010001-06","94% AV Level Silver Plan",,"0.949710547924042","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","$1,700",,,"Not Applicable","Not Applicable","$850","$1,700",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"Not Applicable","Not Applicable","$0","$0","$300","$120","$40","$190","$0","$250","$70","$220","9"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010002","IdealCare Total","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/gold","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/gold","www.senderohealth.com/idealcareformulary/","71837tx0010002-01","Standard Gold On Exchange Plan",,"0.81973671913147","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"Not Applicable","Not Applicable","$0","$0","$750","$270","$350","$190","$0","$300","$700","$220","10"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010002","IdealCare Total","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/gold","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/gold","www.senderohealth.com/idealcareformulary/","71837tx0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010002","IdealCare Total","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/gold","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/gold","www.senderohealth.com/idealcareformulary/","71837tx0010002-03","Limited Cost Sharing Plan Variation",,"0.81973671913147","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","$4,200","$8,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"Not Applicable","Not Applicable","$0","$0","$750","$270","$350","$190","$0","$300","$700","$220","12"
"2014","TX","71837","HIOS","8","2014-01-21 08:29:49","1","71837","TX","Individual","No","27-5219887","71837tx0010003","IdealCare Essential","71837tx001","7386647516","TXN001","TXS001","TXF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Cardiology, Cardiovascular (Heart, Blood Vessels),ENT (Ears, Nose, Throat),Hematology (Blood),Oncology (Cancer),Otology (Ears),Genetics (Inherited Diseases, Birth Defects),Pulmonology (Lungs, Breathing),Gastroenterology (Stomach, Digestion),Neurology (Brain, Nervous System),Pediatrician (Babies, Children), ÞAllergist (Allergies),Chiropractor (Bones, Joints),Rheumatologist (Joints, Muscles, Tendons),Urology (Urinary Tract),Surgery (Operations),Radiology (X-Rays),Psychiatry (Mental Illness),Podiatry (Feet, Toenails),Optometrist (Eyes, Glasses),Otolaryngology (Ear, Nose, and Throat),Orthopedics (Bones and Joints),Ophthalmology (Eyes),Obstetrics/Gynecology (Pregnancy, Women’s Health), ÞNeurosurgery (Operations of the Brain, Spinal Cord),Nuclear Medicine (Testing, e.g.,. MRI, CAT scan),Nephrology (Kidney),Internal Medicine (General Medical Care), ÞFamily Practice (General Family Medical Care), ÞEndocrinology (Glands),Dermatology (Skin),Cardiothoracic Surgery (Operations of the Heart and Chest),Ambulatory Medicine (General Non-emergency Care),Immunology (Immune System),Infectious Diseases (Viral/Bacterial Infections),Neonatology/Perinatology (Fetus and Newborns),Oral-Maxillofacial Surgery (Jaw and Mouth),Physical Medicine (Rehabilitation),Plastic Surgery (Corrective Surgery),Renal (Kidney),Retrovirology (Viral Diseases, AIDS),Adolescent Medicine (Teenagers),Sports Medicine (Sports Injuries),Nutrition/GI (Eating, Digestion),Colon/Rectal (Bowels),Thoracic Surgery (Chest Surgery),Occupational Medicine (Work-Related Injuries),Hepatology (Liver),Reproductive Endocronology (Reproductive System Diseases),Vascular Surgery (Operations of the Blood Vessels)",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care","No",,"No","www.senderohealth.com/idealcarebenefits/bronze","www.senderohealth.com/idealcareenroll","www.senderohealth.com/idealcareplandetails/bronze","www.senderohealth.com/idealcareformulary/","71837tx0010003-01","Standard Bronze On Exchange Plan",,"0.608645975589752","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$1,500","$540","$140","$190","$1,270","$450","$30","$220","13"
"2014","TX","72166","HIOS","1","2013-06-06 10:50:48","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010001","DentalConnect�","72166TX001",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"72166TX0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","72166","HIOS","1","2013-06-06 10:50:48","1","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010002","DentalConnect�","72166TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.92",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"72166TX0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","72166","HIOS","1","2013-06-06 10:50:48","2","72166","TX","SHOP (Small Group)","Yes","35-0472300","72166TX0010003","DentalConnect�","72166TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"72166TX0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010002","Ambetter Gold 2","87226TX001",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010002","Ambetter Gold 2","87226TX001",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010002","Ambetter Gold 2","87226TX001",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","1","87226","TX","Individual","No","74-2770542","87226TX0010005","Ambetter Silver 1","87226TX001",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0010005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020012","Ambetter Bronze 3 + Vision","87226TX002",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020013","Ambetter Bronze 4 + Vision","87226TX002",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020013","Ambetter Bronze 4 + Vision","87226TX002",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","5","87226","TX","Individual","No","74-2770542","87226TX0020013","Ambetter Bronze 4 + Vision","87226TX002",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","6","87226","TX","Individual","No","74-2770542","87226TX0020008","Ambetter Silver 4 + Vision","87226TX002",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.981792304789229",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0020008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030002","Ambetter Gold 2 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030002","Ambetter Gold 2 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030002","Ambetter Gold 2 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030005","Ambetter Silver 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030007","Ambetter Silver 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","7","87226","TX","Individual","No","74-2770542","87226TX0030009","Ambetter Silver 5 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030004","Ambetter Gold 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030004","Ambetter Gold 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030004","Ambetter Gold 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030010","Ambetter Bronze 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030010","Ambetter Bronze 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030010","Ambetter Bronze 1 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030012","Ambetter Bronze 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030012","Ambetter Bronze 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030012","Ambetter Bronze 3 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030013","Ambetter Bronze 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030013","Ambetter Bronze 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","8","87226","TX","Individual","No","74-2770542","87226TX0030013","Ambetter Bronze 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","TX","87226","HIOS","5","2014-01-21 08:29:49","9","87226","TX","Individual","No","74-2770542","87226TX0030008","Ambetter Silver 4 + Vision + Adult Dental","87226TX003",,"TXN001","TXS001","TXF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.931393481326943",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.superiorhealthplan.com/benefits","http://ambetter.superiorhealthplan.com/payments","http://ambetter.superiorhealthplan.com/ourplans","http://ambetter.superiorhealthplan.com/formulary","87226TX0030008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","1","91716","TX","Individual","No","06-6033492","91716TX0080001","Aetna Advantage 5750 PD","91716TX008",,"TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998438760582395",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","1","91716","TX","Individual","No","06-6033492","91716TX0080001","Aetna Advantage 5750 PD","91716TX008",,"TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998438760582395",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","1","91716","TX","Individual","No","06-6033492","91716TX0080001","Aetna Advantage 5750 PD","91716TX008",,"TXN001","TXS001","TXF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998438760582395",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","2","91716","TX","Individual","No","06-6033492","91716TX0080002","Aetna Advantage 6350","91716TX008",,"TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","2","91716","TX","Individual","No","06-6033492","91716TX0080002","Aetna Advantage 6350","91716TX008",,"TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","2","91716","TX","Individual","No","06-6033492","91716TX0080002","Aetna Advantage 6350","91716TX008",,"TXN001","TXS001","TXF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","4","91716","TX","Individual","No","06-6033492","91716TX0080004","Aetna AdvantagePlus 5500 PD","91716TX008",,"TXN001","TXS001","TXF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","4","91716","TX","Individual","No","06-6033492","91716TX0080004","Aetna AdvantagePlus 5500 PD","91716TX008",,"TXN001","TXS001","TXF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","4","91716","TX","Individual","No","06-6033492","91716TX0080004","Aetna AdvantagePlus 5500 PD","91716TX008",,"TXN001","TXS001","TXF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","5","91716","TX","Individual","No","06-6033492","91716TX0080008","Aetna Classic 3500 PD","91716TX008",,"TXN001","TXS001","TXF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","6","91716","TX","Individual","No","06-6033492","91716TX0080009","Aetna Classic 5000","91716TX008",,"TXN001","TXS001","TXF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080009-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","8","91716","TX","Individual","No","06-6033492","91716TX0080007","Aetna Premier 2000 PD","91716TX008",,"TXN001","TXS001","TXF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","8","91716","TX","Individual","No","06-6033492","91716TX0080007","Aetna Premier 2000 PD","91716TX008",,"TXN001","TXS001","TXF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","8","91716","TX","Individual","No","06-6033492","91716TX0080007","Aetna Premier 2000 PD","91716TX008",,"TXN001","TXS001","TXF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","91716","HIOS","6","2013-09-17 16:07:07","9","91716","TX","Individual","No","06-6033492","91716TX0080005","Aetna Basic","91716TX008",,"TXN001","TXS001","TXF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.998449336595851",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/tx.html","91716TX0080005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010010","PPO CO 80-60 $500 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010010-01","Standard Platinum On Exchange Plan","88.30%","0.883324682712555","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370008","Unity UW Health Gold D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/D","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/D","http://unityhealth.com/HIX/Formulary","37833WI0370008-03","Limited Cost Sharing Plan Variation",,"0.780644714832306","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","2","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0120002","Smile for Health Family C60A50","97937TX012",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a50-ppo.pdf",,,,"97937TX0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","3","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0190001","Smile for Health Child C60","97937TX019",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","3","97937","TX","Individual","Yes","86-0307623","97937TX0020001","Smile for Health Child C60A60","97937TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","8","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0160001","Smile for Health Child C80A50","97937TX016",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","8","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0160002","Smile for Health Family C80A50","97937TX016",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","9","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0140001","Smile for Health Child C80A60","97937TX014",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-04","73% AV Level Silver Plan",,"0.739394783973694","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-05","87% AV Level Silver Plan",,"0.877577483654022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010059","Dean HSA 5000X","38345WI001",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010059","Dean HSA 5000X","38345WI001",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010059-03","Limited Cost Sharing Plan Variation",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370005","Unity UW Health Platinum B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/B/","http://unityhealth.com/HIX/Formulary","37833WI0370005-03","Limited Cost Sharing Plan Variation","91.99%","0.919891595840454","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370006","Unity UW Health Platinum A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/A/","http://unityhealth.com/HIX/Formulary","37833WI0370006-01","Standard Platinum On Exchange Plan",,"0.919117987155914","No","No","No","100%",,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370004","Unity UW Health Platinum C","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/C/","http://unityhealth.com/HIX/Formulary","37833WI0370004-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370004","Unity UW Health Platinum C","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/C/","http://unityhealth.com/HIX/Formulary","37833WI0370004-03","Limited Cost Sharing Plan Variation",,"0.881066024303436","No","No","No","100%",,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","3","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020004",,"16837WI0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010003","PPO CO 90-70 $0 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010003-01","Standard Platinum On Exchange Plan","91.20%","0.911612868309021","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370009","Unity UW Health Gold E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/E","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/E","http://unityhealth.com/HIX/Formulary","37833WI0370009-01","Standard Gold On Exchange Plan",,"0.780208289623261","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370009","Unity UW Health Gold E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/E","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/E","http://unityhealth.com/HIX/Formulary","37833WI0370009-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500  - 10%","38166WI015",,"WIN001","WIS001","WIF007","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150001-01","Standard Platinum On Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,750","$3,500","$2,750","$5,500","$500","$1,000","10%",,,,"$750","$1,500","$1,250","$2,500","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN001","WIS001","WIF005","New","POS","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150002-00","Standard Gold Off Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,500","$15,000","$12,500","$25,000","$1,000","$2,000","20%",,,,"$1,500","$3,000","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","New","EPO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180001-00","Standard Gold Off Exchange Plan","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","New","EPO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180001-01","Standard Gold On Exchange Plan","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150002","Independence $1,000 - 20%","38166WI015",,"WIN001","WIS001","WIF005","New","POS","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150002-01","Standard Gold On Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,500","$15,000","$12,500","$25,000","$1,000","$2,000","20%",,,,"$1,500","$3,000","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150003","Independence - $1,000 - 40%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150003-00","Standard Silver Off Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$7,750","$15,500","$13,750","$27,500","$1,000","$2,000","40%",,,,"$1,500","$3,000","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","TX","92388","HIOS","6","2013-10-15 07:27:56","1","92388","TX","SHOP (Small Group)","Yes","13-5581929","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN003","TXS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$14.68",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058",,"92388TX0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","Individual","Yes","86-0307623","97937TX0070002","Smile for Health Family C80A80","97937TX007",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$40.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","Individual","Yes","86-0307623","97937TX0070002","Smile for Health Family C80A80","97937TX007",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$40.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140001-00","Standard Platinum Off Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170001-00","Standard Gold Off Exchange Plan","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140001","Tradition $500 - 10%","38166WI014",,"WIN001","WIS001","WIF007","New","HMO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140001-01","Standard Platinum On Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170001-01","Standard Gold On Exchange Plan","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370001","Unity UW Health Platinum F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/F/","http://unityhealth.com/HIX/Formulary","37833WI0370001-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370010","Unity UW Health Gold A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/A","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/A","http://unityhealth.com/HIX/Formulary","37833WI0370010-01","Standard Gold On Exchange Plan",,"0.819815397262573","No","No","No","100%",,"$4,100","$8,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370010","Unity UW Health Gold A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/A","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/A","http://unityhealth.com/HIX/Formulary","37833WI0370010-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370002","Unity UW Health Platinum E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/E/","http://unityhealth.com/HIX/Formulary","37833WI0370002-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370002","Unity UW Health Platinum E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/E/","http://unityhealth.com/HIX/Formulary","37833WI0370002-03","Limited Cost Sharing Plan Variation",,"0.880417287349701","No","No","No","100%",,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370003","Unity UW Health Platinum D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/D/","http://unityhealth.com/HIX/Formulary","37833WI0370003-01","Standard Platinum On Exchange Plan",,"0.881243407726288","No","No","No","100%",,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-06","94% AV Level Silver Plan",,"0.948680698871613","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-01","Standard Silver On Exchange Plan",,"0.680290997028351","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","3","97937","TX","Individual","Yes","86-0307623","97937TX0020001","Smile for Health Child C60A60","97937TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","3","97937","TX","Individual","Yes","86-0307623","97937TX0020002","Smile for Health Family C60A60","97937TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","92388","HIOS","6","2013-10-15 07:27:56","1","92388","TX","SHOP (Small Group)","Yes","13-5581929","92388TX0190001","Family Basic Dental Plan (Low)","92388TX019",,"TXN003","TXS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$14.68",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48059",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48058",,"92388TX0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","92388","HIOS","6","2013-10-15 07:27:56","2","92388","TX","SHOP (Small Group)","Yes","13-5581929","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN004","TXS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125",,"92388TX0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","92388","HIOS","6","2013-10-15 07:27:56","2","92388","TX","SHOP (Small Group)","Yes","13-5581929","92388TX0200001","Family Enhanced Dental Plan (High)","92388TX020",,"TXN004","TXS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49126",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49125",,"92388TX0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","Individual","Yes","86-0307623","97937TX0010002","Smile for Health Family C60A70","97937TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0150001","Smile for Health Child C80A80","97937TX015",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c80a80-ppo.pdf",,,,"97937TX0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","Individual","Yes","86-0307623","97937TX0010002","Smile for Health Family C60A70","97937TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0150001","Smile for Health Child C80A80","97937TX015",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c80a80-ppo.pdf",,,,"97937TX0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0150002","Smile for Health Family C80A80","97937TX015",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c80a80-ppo.pdf",,,,"97937TX0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","Individual","Yes","86-0307623","97937TX0010001","Smile for Health Child C60A70","97937TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0150002","Smile for Health Family C80A80","97937TX015",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c80a80-ppo.pdf",,,,"97937TX0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","1","97937","TX","Individual","Yes","86-0307623","97937TX0010001","Smile for Health Child C60A70","97937TX001",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c60a70-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","2","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0120001","Smile for Health Child C60A50","97937TX012",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a50-ppo.pdf",,,,"97937TX0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","2","97937","TX","Individual","Yes","86-0307623","97937TX0170001","Smile for Health Child C60","97937TX017",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","2","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0120001","Smile for Health Child C60A50","97937TX012",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a50-ppo.pdf",,,,"97937TX0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","2","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0120002","Smile for Health Family C60A50","97937TX012",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a50-ppo.pdf",,,,"97937TX0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010004","PPO CO 90-70 $0 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010004-01","Standard Platinum On Exchange Plan","91.80%","0.918204963207245","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010005","PPO CO 80-60 $0 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010005-01","Standard Platinum On Exchange Plan","91.10%","0.910820364952087","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010006","PPO CO 80-60 $0 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010006-01","Standard Platinum On Exchange Plan","90.70%","0.906812191009521","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010007","PPO CO 90-70 $500 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010007-01","Standard Platinum On Exchange Plan","89.10%","0.890807807445526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010008","PPO CO 90-70 $500 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010008-01","Standard Platinum On Exchange Plan","88.60%","0.88584566116333","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010009","PPO CO 80-60 $500 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010009-01","Standard Platinum On Exchange Plan","89.50%","0.895487248897552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","New","EPO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180001","Select $1,000 - 20%","38166WI018",,"WIN002","WIS002","WIF001","New","EPO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180001-03","Limited Cost Sharing Plan Variation","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150003","Independence - $1,000 - 40%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150003-01","Standard Silver On Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$7,750","$15,500","$13,750","$27,500","$1,000","$2,000","40%",,,,"$1,500","$3,000","$2,500","$5,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-00","Standard Silver Off Exchange Plan","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160008","Reliance $2,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160008-01","Standard Silver On Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160009","Reliance $4,000 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160009-00","Standard Bronze Off Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-05","87% AV Level Silver Plan","87.65%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160009","Reliance $4,000 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160009-01","Standard Bronze On Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","3","97937","TX","Individual","Yes","86-0307623","97937TX0020002","Smile for Health Family C60A60","97937TX002",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-family-c60a60-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","4","97937","TX","Individual","Yes","86-0307623","97937TX0040001","Smile for Health Child C60A50","97937TX004",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","4","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0200001","Smile for Health Child C80","97937TX020",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","4","97937","TX","Individual","Yes","86-0307623","97937TX0040002","Smile for Health Family C60A50","97937TX004",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$35.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","5","97937","TX","Individual","Yes","86-0307623","97937TX0180001","Smile for Health Child C80","97937TX018",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","5","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0100001","Smile for Health Child C60A60","97937TX010",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a60-ppo.pdf",,,,"97937TX0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","5","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0100001","Smile for Health Child C60A60","97937TX010",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a60-ppo.pdf",,,,"97937TX0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","5","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0100002","Smile for Health Family C60A60","97937TX010",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a60-ppo.pdf",,,,"97937TX0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","5","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0100002","Smile for Health Family C60A60","97937TX010",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a60-ppo.pdf",,,,"97937TX0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","Individual","Yes","86-0307623","97937TX0070001","Smile for Health Child C80A80","97937TX007",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0090001","Smile for Health Child C60A70","97937TX009",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a70-ppo.pdf",,,,"97937TX0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0090001","Smile for Health Child C60A70","97937TX009",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-child-c60a70-ppo.pdf",,,,"97937TX0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","Individual","Yes","86-0307623","97937TX0070001","Smile for Health Child C80A80","97937TX007",,"TXN001","TXS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$40.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-indv-child-c80a80-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-tx-idental",,,"97937TX0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0090002","Smile for Health Family C60A70","97937TX009",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a70-ppo.pdf",,,,"97937TX0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN001","WIS001","WIF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140004-00","Standard Gold Off Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140004","Tradition $1,000 - 20%","38166WI014",,"WIN001","WIS001","WIF005","New","HMO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140004-01","Standard Gold On Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170001","Classic $1,000 - 20%","38166WI017",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $20 per visit to MOOP Emergency Room: $100 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $100 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170001-03","Limited Cost Sharing Plan Variation","81.90%","0.797870516777039","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370001","Unity UW Health Platinum F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/F/","http://unityhealth.com/HIX/Formulary","37833WI0370001-03","Limited Cost Sharing Plan Variation",,"0.880235910415649","No","No","No","100%",,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370002","Unity UW Health Platinum E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/E/","http://unityhealth.com/HIX/Formulary","37833WI0370002-01","Standard Platinum On Exchange Plan",,"0.880417287349701","No","No","No","100%",,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370051","Unity UW Health Gold HSA G","37833WI037","7114920342","WIN001","WIS001","WIF003","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/G/","http://unityhealth.com/HIX/Formulary","37833WI0370051-01","Standard Gold On Exchange Plan",,"0.819058358669281","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370051","Unity UW Health Gold HSA G","37833WI037","7114920342","WIN001","WIS001","WIF003","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/G/","http://unityhealth.com/HIX/Formulary","37833WI0370051-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370051","Unity UW Health Gold HSA G","37833WI037","7114920342","WIN001","WIS001","WIF003","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/G/","http://unityhealth.com/HIX/Formulary","37833WI0370051-03","Limited Cost Sharing Plan Variation",,"0.819058358669281","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370052","Unity UW Health Gold HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/H/","http://unityhealth.com/HIX/Formulary","37833WI0370052-01","Standard Gold On Exchange Plan",,"0.780754089355469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","6","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0090002","Smile for Health Family C60A70","97937TX009",,"TXN001","TXS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-tx-grp-family-c60a70-ppo.pdf",,,,"97937TX0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","7","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0130001","Smile for Health Child C80A70","97937TX013",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","7","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0130002","Smile for Health Family C80A70","97937TX013",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","9","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0140002","Smile for Health Family C80A60","97937TX014",,"TXN001","TXS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$30.29",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","10","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0110001","Smile for Health Child C60A80","97937TX011",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","TX","97937","HIOS","4","2013-09-10 14:43:20","10","97937","TX","SHOP (Small Group)","Yes","86-0307623","97937TX0110002","Smile for Health Family C60A80","97937TX011",,"TXN001","TXS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers’ Compensation or employer’s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company’s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.84",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"97937TX0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","Individual","Yes","75-1233841","16837WI0010001","Dentegra Dental PPO Children's Plan 70","16837WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010001",,"16837WI0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020001",,"16837WI0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","Individual","Yes","75-1233841","16837WI0010001","Dentegra Dental PPO Children's Plan 70","16837WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010001",,"16837WI0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020001",,"16837WI0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020002",,"16837WI0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","Individual","Yes","75-1233841","16837WI0010002","Dentegra Dental PPO Children's Plan 85","16837WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.64",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010002",,"16837WI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","Individual","Yes","75-1233841","16837WI0010002","Dentegra Dental PPO Children's Plan 85","16837WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.64",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010002",,"16837WI0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","1","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020002",,"16837WI0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","2","16837","WI","Individual","Yes","75-1233841","16837WI0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","16837WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010006",,"16837WI0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","2","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020006",,"16837WI0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","2","16837","WI","Individual","Yes","75-1233841","16837WI0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","16837WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010006",,"16837WI0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","2","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.55",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020006",,"16837WI0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","3","16837","WI","Individual","Yes","75-1233841","16837WI0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","16837WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.64",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010004",,"16837WI0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","3","16837","WI","SHOP (Small Group)","Yes","75-1233841","16837WI0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","16837WI002",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/wi/16837wi0020004",,"16837WI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","16837","HIOS","5","2014-01-17 09:36:20","3","16837","WI","Individual","Yes","75-1233841","16837WI0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","16837WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.64",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wi/16837wi0010004",,"16837WI0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370017","Unity UW Health Platinum E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370017-01","Standard Platinum On Exchange Plan",,"0.880417287349701","No","No","No","100%",,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370017","Unity UW Health Platinum E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370017-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370017","Unity UW Health Platinum E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370017-03","Limited Cost Sharing Plan Variation",,"0.880417287349701","No","No","No","100%",,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370018","Unity UW Health Platinum D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370018-01","Standard Platinum On Exchange Plan",,"0.881243407726288","No","No","No","100%",,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370018","Unity UW Health Platinum D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370018-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370018","Unity UW Health Platinum D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370018-03","Limited Cost Sharing Plan Variation",,"0.881243407726288","No","No","No","100%",,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370019","Unity UW Health Platinum C w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/CDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/CDental","http://unityhealth.com/HIX/Formulary","37833WI0370019-01","Standard Platinum On Exchange Plan",,"0.881066024303436","No","No","No","100%",,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370019","Unity UW Health Platinum C w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/CDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/CDental","http://unityhealth.com/HIX/Formulary","37833WI0370019-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180007-00","Standard Bronze Off Exchange Plan","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370009","Unity UW Health Gold E","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/E","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/E","http://unityhealth.com/HIX/Formulary","37833WI0370009-03","Limited Cost Sharing Plan Variation",,"0.780208289623261","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-00","Standard Silver Off Exchange Plan","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140006","Tradition $1,000 - 40%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140006-00","Standard Silver Off Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010011","PPO CO 80-60 $1250 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010011-01","Standard Gold On Exchange Plan","82.00%","0.819660723209381","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010012","PPO CO 80-60 $1250 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010012-01","Standard Gold On Exchange Plan","82.00%","0.819542109966278","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010013","PPO CO 80-60 $2000 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010013-01","Standard Gold On Exchange Plan","78.10%","0.780282735824585","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$8,750","$17,500","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010014","PPO CO 80-60 $2000 Deductible; $10/$25/$50 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010014-01","Standard Gold On Exchange Plan","79.00%","0.788441300392151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,750","$17,500","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010015","PPO CO 60-40 $2000 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010015-01","Standard Silver On Exchange Plan","71.80%","0.718986630439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","35334","HIOS","3","2013-08-14 11:02:32","1","35334","WI","SHOP (Small Group)","No","39-1768192","35334WI0010016","PPO CO 70-50 $2500 Deductible; $20/$40/$60 Rx","35334WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","Yes","Providers in HealthEOS, Multiplan or PHCS PPO networks","Yes","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","35334WI0010016-01","Standard Silver On Exchange Plan","71.50%","0.715973556041718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370001","Unity UW Health Platinum F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/F/","http://unityhealth.com/HIX/Formulary","37833WI0370001-01","Standard Platinum On Exchange Plan",,"0.880235910415649","No","No","No","100%",,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370003","Unity UW Health Platinum D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/D/","http://unityhealth.com/HIX/Formulary","37833WI0370003-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370003","Unity UW Health Platinum D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/D/","http://unityhealth.com/HIX/Formulary","37833WI0370003-03","Limited Cost Sharing Plan Variation",,"0.881243407726288","No","No","No","100%",,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370004","Unity UW Health Platinum C","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/C/","http://unityhealth.com/HIX/Formulary","37833WI0370004-01","Standard Platinum On Exchange Plan",,"0.881066024303436","No","No","No","100%",,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370005","Unity UW Health Platinum B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/B/","http://unityhealth.com/HIX/Formulary","37833WI0370005-01","Standard Platinum On Exchange Plan","91.99%","0.919891595840454","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370005","Unity UW Health Platinum B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/B/","http://unityhealth.com/HIX/Formulary","37833WI0370005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370020","Unity UW Health Platinum B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370020-01","Standard Platinum On Exchange Plan","91.99%","0.919891595840454","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370020","Unity UW Health Platinum B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370020","Unity UW Health Platinum B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370020-03","Limited Cost Sharing Plan Variation","91.99%","0.919891595840454","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370021","Unity UW Health Platinum A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370021-01","Standard Platinum On Exchange Plan",,"0.919117987155914","No","No","No","100%",,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370021","Unity UW Health Platinum A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370021-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370021","Unity UW Health Platinum A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370021-03","Limited Cost Sharing Plan Variation",,"0.919117987155914","No","No","No","100%",,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370023","Unity UW Health Gold D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370023-01","Standard Gold On Exchange Plan",,"0.780644714832306","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370023","Unity UW Health Gold D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370023-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370006","Unity UW Health Platinum A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/A/","http://unityhealth.com/HIX/Formulary","37833WI0370006-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370006","Unity UW Health Platinum A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/A/","http://unityhealth.com/HIX/Formulary","37833WI0370006-03","Limited Cost Sharing Plan Variation",,"0.919117987155914","No","No","No","100%",,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370008","Unity UW Health Gold D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/D","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/D","http://unityhealth.com/HIX/Formulary","37833WI0370008-01","Standard Gold On Exchange Plan",,"0.780644714832306","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370008","Unity UW Health Gold D","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/D","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/D","http://unityhealth.com/HIX/Formulary","37833WI0370008-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370010","Unity UW Health Gold A","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/A","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/A","http://unityhealth.com/HIX/Formulary","37833WI0370010-03","Limited Cost Sharing Plan Variation",,"0.819815397262573","No","No","No","100%",,"$4,100","$8,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370011","Unity UW Health Gold B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/B","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/B","http://unityhealth.com/HIX/Formulary","37833WI0370011-01","Standard Gold On Exchange Plan",,"0.819725751876831","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370011","Unity UW Health Gold B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/B","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/B","http://unityhealth.com/HIX/Formulary","37833WI0370011-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370011","Unity UW Health Gold B","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/B","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/B","http://unityhealth.com/HIX/Formulary","37833WI0370011-03","Limited Cost Sharing Plan Variation",,"0.819725751876831","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-01","Standard Silver On Exchange Plan",,"0.686055660247803","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,300","$8,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-03","Limited Cost Sharing Plan Variation",,"0.686055660247803","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,300","$8,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-04","73% AV Level Silver Plan",,"0.73862898349762","No","No","No","100%",,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,800","$5,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-05","87% AV Level Silver Plan",,"0.879536807537079","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370013","Unity UW Health Silver E","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/E/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/E/","http://unityhealth.com/HIX/Formulary","37833WI0370013-06","94% AV Level Silver Plan",,"0.949200212955475","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-01","Standard Silver On Exchange Plan","70.01%","0.700128376483917","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-03","Limited Cost Sharing Plan Variation","70.01%","0.700128376483917","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-04","73% AV Level Silver Plan","73.97%","0.739691555500031","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,700","$9,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-05","87% AV Level Silver Plan","87.95%","0.879474580287933","No","No","No","100%",,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370014","Unity UW Health Silver D","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/D/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/D/","http://unityhealth.com/HIX/Formulary","37833WI0370014-06","94% AV Level Silver Plan","94.89%","0.948940515518188","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-01","Standard Silver On Exchange Plan","71.86%","0.718627035617828","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-03","Limited Cost Sharing Plan Variation","71.86%","0.718627035617828","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-04","73% AV Level Silver Plan","73.97%","0.739731550216675","No","No","No","100%",,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-05","87% AV Level Silver Plan","87.94%","0.879384338855743","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","1","37833","WI","Individual","No","39-1450766","37833WI0370015","Unity UW Health Silver B","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/B/","http://unityhealth.com/HIX/Formulary","37833WI0370015-06","94% AV Level Silver Plan","94.88%","0.948761522769928","No","No","No","100%",,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370016","Unity UW Health Platinum F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370016-01","Standard Platinum On Exchange Plan",,"0.880235910415649","No","No","No","100%",,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370016","Unity UW Health Platinum F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370016-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370016","Unity UW Health Platinum F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370016-03","Limited Cost Sharing Plan Variation",,"0.880235910415649","No","No","No","100%",,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370019","Unity UW Health Platinum C w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Platinum","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Platinum/CDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Platinum/CDental","http://unityhealth.com/HIX/Formulary","37833WI0370019-03","Limited Cost Sharing Plan Variation",,"0.881066024303436","No","No","No","100%",,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370023","Unity UW Health Gold D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370023-03","Limited Cost Sharing Plan Variation",,"0.780644714832306","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370024","Unity UW Health Gold E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370024-01","Standard Gold On Exchange Plan",,"0.780208289623261","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370024","Unity UW Health Gold E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370024-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370024","Unity UW Health Gold E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370024-03","Limited Cost Sharing Plan Variation",,"0.780208289623261","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370025","Unity UW Health Gold A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370025-01","Standard Gold On Exchange Plan",,"0.819815397262573","No","No","No","100%",,"$4,100","$8,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370025","Unity UW Health Gold A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370025-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370025","Unity UW Health Gold A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370025-03","Limited Cost Sharing Plan Variation",,"0.819815397262573","No","No","No","100%",,"$4,100","$8,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370026","Unity UW Health Gold B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370026-01","Standard Gold On Exchange Plan",,"0.819725751876831","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370026","Unity UW Health Gold B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370026-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370026","Unity UW Health Gold B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370026-03","Limited Cost Sharing Plan Variation",,"0.819725751876831","No","No","No","100%",,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-01","Standard Silver On Exchange Plan",,"0.686055660247803","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,300","$8,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-03","Limited Cost Sharing Plan Variation",,"0.686055660247803","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,300","$8,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-04","73% AV Level Silver Plan",,"0.73862898349762","No","No","No","100%",,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,800","$5,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-05","87% AV Level Silver Plan",,"0.879536807537079","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370028","Unity UW Health Silver E w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/EDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/EDental","http://unityhealth.com/HIX/Formulary","37833WI0370028-06","94% AV Level Silver Plan",,"0.949200212955475","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$50","$100","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-01","Standard Silver On Exchange Plan","70.01%","0.700128376483917","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-03","Limited Cost Sharing Plan Variation","70.01%","0.700128376483917","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-04","73% AV Level Silver Plan","73.97%","0.739691555500031","No","No","No","100%",,"$4,700","$9,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,700","$9,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-05","87% AV Level Silver Plan","87.95%","0.879474580287933","No","No","No","100%",,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370029","Unity UW Health Silver D w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/DDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/DDental","http://unityhealth.com/HIX/Formulary","37833WI0370029-06","94% AV Level Silver Plan","94.89%","0.948940515518188","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-01","Standard Silver On Exchange Plan","71.86%","0.718627035617828","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-03","Limited Cost Sharing Plan Variation","71.86%","0.718627035617828","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-04","73% AV Level Silver Plan","73.97%","0.739731550216675","No","No","No","100%",,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,100","$4,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-05","87% AV Level Silver Plan","87.94%","0.879384338855743","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","2","37833","WI","Individual","No","39-1450766","37833WI0370030","Unity UW Health Silver B w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/BDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/BDental","http://unityhealth.com/HIX/Formulary","37833WI0370030-06","94% AV Level Silver Plan","94.88%","0.948761522769928","No","No","No","100%",,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370031","Unity UW Health Gold F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/F","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/F","http://unityhealth.com/HIX/Formulary","37833WI0370031-01","Standard Gold On Exchange Plan",,"0.780748248100281","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$950","$1,900","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370031","Unity UW Health Gold F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/F","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/F","http://unityhealth.com/HIX/Formulary","37833WI0370031-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370031","Unity UW Health Gold F","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/F","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/F","http://unityhealth.com/HIX/Formulary","37833WI0370031-03","Limited Cost Sharing Plan Variation",,"0.780748248100281","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$950","$1,900","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-01","Standard Silver On Exchange Plan",,"0.685542702674866","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-03","Limited Cost Sharing Plan Variation",,"0.685542702674866","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-04","73% AV Level Silver Plan",,"0.737785518169403","No","No","No","100%",,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,100","$2,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-05","87% AV Level Silver Plan",,"0.879263162612915","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$275","$550","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370032","Unity UW Health Silver G","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/G/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/G/","http://unityhealth.com/HIX/Formulary","37833WI0370032-06","94% AV Level Silver Plan",,"0.949946701526642","No","No","No","100%",,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-01","Standard Silver On Exchange Plan",,"0.681431770324707","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,300","$4,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-03","Limited Cost Sharing Plan Variation",,"0.681431770324707","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,300","$4,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-04","73% AV Level Silver Plan",,"0.738031148910522","No","No","No","100%",,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,900","$3,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-05","87% AV Level Silver Plan",,"0.879639387130737","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$475","$950","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370033","Unity UW Health Silver F","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/F/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/F/","http://unityhealth.com/HIX/Formulary","37833WI0370033-06","94% AV Level Silver Plan",,"0.948187351226807","No","No","No","100%",,"$300","$600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-01","Standard Silver On Exchange Plan",,"0.715489327907562","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,400","$2,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-03","Limited Cost Sharing Plan Variation",,"0.715489327907562","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,400","$2,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-04","73% AV Level Silver Plan",,"0.738727569580078","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,300","$2,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-05","87% AV Level Silver Plan",,"0.877642512321472","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$650","$1,300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","3","37833","WI","Individual","No","39-1450766","37833WI0370034","Unity UW Health Silver A","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/A/","http://unityhealth.com/HIX/Formulary","37833WI0370034-06","94% AV Level Silver Plan",,"0.949946701526642","No","No","No","100%",,"$450","$900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370035","Unity UW Health Gold F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370035-01","Standard Gold On Exchange Plan",,"0.780748248100281","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$950","$1,900","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370035","Unity UW Health Gold F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370035-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370035","Unity UW Health Gold F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF001","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370035-03","Limited Cost Sharing Plan Variation",,"0.780748248100281","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$950","$1,900","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-01","Standard Silver On Exchange Plan",,"0.685542702674866","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-03","Limited Cost Sharing Plan Variation",,"0.685542702674866","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,600","$3,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-04","73% AV Level Silver Plan",,"0.737785518169403","No","No","No","100%",,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,100","$2,200","45%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-05","87% AV Level Silver Plan",,"0.879263162612915","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$275","$550","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-03","Limited Cost Sharing Plan Variation","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-04","73% AV Level Silver Plan","74.00%","0.73924720287323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-05","87% AV Level Silver Plan","87.30%","0.872929096221924","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-06","94% AV Level Silver Plan","93.80%","0.933220684528351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-04","73% AV Level Silver Plan","73.62%","0.736194789409637","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-05","87% AV Level Silver Plan","86.49%","0.864901006221771","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-03","Limited Cost Sharing Plan Variation","68.06%","0.680645763874054","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-04","73% AV Level Silver Plan","73.75%","0.737509369850159","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-05","87% AV Level Silver Plan","87.04%","0.870420694351196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - HDHP","38166WI015",,"WIN001","WIS001","WIF006","New","POS","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150005-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"28"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150005","Independence $2,000 - HDHP","38166WI015",,"WIN001","WIS001","WIF006","New","POS","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150005-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"29"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370036","Unity UW Health Silver G w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/GDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/GDental","http://unityhealth.com/HIX/Formulary","37833WI0370036-06","94% AV Level Silver Plan",,"0.949946701526642","No","No","No","100%",,"$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-01","Standard Silver On Exchange Plan",,"0.681431770324707","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,300","$4,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-03","Limited Cost Sharing Plan Variation",,"0.681431770324707","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,300","$4,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-04","73% AV Level Silver Plan",,"0.738031148910522","No","No","No","100%",,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,900","$3,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-05","87% AV Level Silver Plan",,"0.879639387130737","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$475","$950","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370037","Unity UW Health Silver F w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/FDental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/FDental","http://unityhealth.com/HIX/Formulary","37833WI0370037-06","94% AV Level Silver Plan",,"0.948187351226807","No","No","No","100%",,"$300","$600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-01","Standard Silver On Exchange Plan",,"0.715489327907562","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,400","$2,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-03","Limited Cost Sharing Plan Variation",,"0.715489327907562","No","No","No","100%",,"$5,400","$10,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,400","$2,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-04","73% AV Level Silver Plan",,"0.738727569580078","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,300","$2,600","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-05","87% AV Level Silver Plan",,"0.877642512321472","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$650","$1,300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","4","37833","WI","Individual","No","39-1450766","37833WI0370038","Unity UW Health Silver A w/Dental","37833WI037","7114920342","WIN001","WIS001","WIF002","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/ADental","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/ADental","http://unityhealth.com/HIX/Formulary","37833WI0370038-06","94% AV Level Silver Plan",,"0.949946701526642","No","No","No","100%",,"$450","$900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$800","$1,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370039","Unity UW Health Bronze A","37833WI037","7114920342","WIN001","WIS001","WIF006","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/A/","http://unityhealth.com/HIX/Formulary","37833WI0370039-01","Standard Bronze On Exchange Plan",,"0.617273032665253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370039","Unity UW Health Bronze A","37833WI037","7114920342","WIN001","WIS001","WIF006","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/A/","http://unityhealth.com/HIX/Formulary","37833WI0370039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370039","Unity UW Health Bronze A","37833WI037","7114920342","WIN001","WIS001","WIF006","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/A/","http://unityhealth.com/HIX/Formulary","37833WI0370039-03","Limited Cost Sharing Plan Variation",,"0.617273032665253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370040","Unity UW Health Bronze HSA B","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/B/","http://unityhealth.com/HIX/Formulary","37833WI0370040-01","Standard Bronze On Exchange Plan",,"0.615120649337769","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370040","Unity UW Health Bronze HSA B","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/B/","http://unityhealth.com/HIX/Formulary","37833WI0370040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370040","Unity UW Health Bronze HSA B","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/B/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/B/","http://unityhealth.com/HIX/Formulary","37833WI0370040-03","Limited Cost Sharing Plan Variation",,"0.615120649337769","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370041","Unity UW Health Bronze C","37833WI037","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/C/","http://unityhealth.com/HIX/Formulary","37833WI0370041-01","Standard Bronze On Exchange Plan",,"0.581853449344635","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370041","Unity UW Health Bronze C","37833WI037","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/C/","http://unityhealth.com/HIX/Formulary","37833WI0370041-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370041","Unity UW Health Bronze C","37833WI037","7114920342","WIN001","WIS001","WIF007","New","HMO","Bronze","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Bronze/C/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Bronze/C/","http://unityhealth.com/HIX/Formulary","37833WI0370041-03","Limited Cost Sharing Plan Variation",,"0.581853449344635","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370042","Unity UW Health Catastrophic A","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Catastrophic","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.","Adult-Only Plans","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Catastrophic/A/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Catastrophic/A/","http://unityhealth.com/HIX/Formulary","37833WI0370042-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370052","Unity UW Health Gold HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/H/","http://unityhealth.com/HIX/Formulary","37833WI0370052-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370052","Unity UW Health Gold HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Gold","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Gold/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Gold/H/","http://unityhealth.com/HIX/Formulary","37833WI0370052-03","Limited Cost Sharing Plan Variation",,"0.780754089355469","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-01","Standard Silver On Exchange Plan",,"0.719182133674622","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370053","Unity UW Health Silver HSA H","37833WI037","7114920342","WIN001","WIS001","WIF004","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/H/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/H/","http://unityhealth.com/HIX/Formulary","37833WI0370053-03","Limited Cost Sharing Plan Variation",,"0.719182133674622","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-03","Limited Cost Sharing Plan Variation",,"0.680290997028351","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-04","73% AV Level Silver Plan",,"0.738487541675568","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-05","87% AV Level Silver Plan",,"0.877934873104095","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","WI","37833","HIOS","6","2013-11-23 14:44:18","5","37833","WI","Individual","No","39-1450766","37833WI0370054","Unity UW Health Silver HSA J","37833WI037","7114920342","WIN001","WIS001","WIF005","New","HMO","Silver","No","On the Exchange","No","Yes","As a member of Unity, you have a primary care physician (PCP).  Your PCP will know your medical history, serve as your first contact point for non-emergency care and coordinate your health care across the entire health care delivery system.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Room","Yes","Emergency Room, Limited Coverage for Out of Area Student with approved Prior Authorization","No","http://unityhealth.com/HIX/SBC/Unity-UWHealth/Silver/J/","https://hixenroll.unityhealth.com","http://unityhealth.com/HIX/Unity-UWHealth/Silver/J/","http://unityhealth.com/HIX/Formulary","37833WI0370054-06","94% AV Level Silver Plan",,"0.948312282562256","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","WI","38152","HIOS","1","2013-06-06 10:50:48","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010001","DentalConnect�","38152WI001",,"WIN001","WIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.20",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38152WI0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38152","HIOS","1","2013-06-06 10:50:48","1","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010002","DentalConnect�","38152WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38152WI0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","38152","HIOS","1","2013-06-06 10:50:48","2","38152","WI","SHOP (Small Group)","Yes","35-0472300","38152WI0010003","DentalConnect�","38152WI001",,"WIN001","WIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"38152WI0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-00","Standard Silver Off Exchange Plan","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150007","Independence $1,750 - 20% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150007-00","Standard Silver Off Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$8,625","$17,250","$14,375","$28,750",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$2,625","$5,250","$4,375","$8,750",,,,,,,,,"32"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180007-03","Limited Cost Sharing Plan Variation","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150007","Independence $1,750 - 20% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150007-01","Standard Silver On Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"$8,625","$17,250","$14,375","$28,750",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$2,625","$5,250","$4,375","$8,750",,,,,,,,,"33"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180006-00","Standard Bronze Off Exchange Plan","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150008","Independence $2,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150008-00","Standard Silver Off Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$11,000","$22,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"34"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180006-01","Standard Bronze On Exchange Plan","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150008","Independence $2,000 - 10% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150008-01","Standard Silver On Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$11,000","$22,000","$17,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,"35"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-01","Standard Silver On Exchange Plan","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140006","Tradition $1,000 - 40%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140006-01","Standard Silver On Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140007","Tradition $1,500 - 30%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140007-00","Standard Silver Off Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-03","Limited Cost Sharing Plan Variation","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140007","Tradition $1,500 - 30%","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140007-01","Standard Silver On Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-04","73% AV Level Silver Plan","74.00%","0.73924720287323","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN002","WIS002","WIF007","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160001-00","Standard Platinum Off Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160001","Reliance $500 - 10%","38166WI016",,"WIN002","WIS002","WIF007","New","EPO","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160001-01","Standard Platinum On Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-05","87% AV Level Silver Plan","87.30%","0.872929096221924","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN002","WIS002","WIF005","New","EPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160002-00","Standard Gold Off Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170003","Classic $1,800 - 20%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170003-06","94% AV Level Silver Plan","93.30%","0.933220684528351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-00","Standard Silver Off Exchange Plan","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160002","Reliance $1,000 - 20%","38166WI016",,"WIN002","WIS002","WIF005","New","EPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160002-01","Standard Gold On Exchange Plan","78.64%","0.786382079124451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160003","Reliance $1,000 - 40%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160003-00","Standard Silver Off Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-01","Standard Silver On Exchange Plan","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160003","Reliance $1,000 - 40%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160003-01","Standard Silver On Exchange Plan","70.21%","0.702124893665314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-03","Limited Cost Sharing Plan Variation","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160004","Reliance $1,500 - 30%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160004-00","Standard Silver Off Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-04","73% AV Level Silver Plan","73.30%","0.732791364192963","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160004","Reliance $1,500 - 30%","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160004-01","Standard Silver On Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-05","87% AV Level Silver Plan","87.90%","0.878813982009888","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150001","Independence $500  - 10%","38166WI015",,"WIN001","WIS001","WIF007","New","POS","Platinum","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150001-00","Standard Platinum Off Exchange Plan","89.65%","0.896489024162292","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$1,750","$3,500","$2,750","$5,500","$500","$1,000","10%",,,,"$750","$1,500","$1,250","$2,500","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0170004","Classic $2,000 - 30%","38166WI017",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170004-06","94% AV Level Silver Plan","93.30%","0.933220684528351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150004","Independence - $1,500 - 30%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150004-00","Standard Silver Off Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,250","$20,500","$16,250","$32,500","$1,500","$3,000","30%",,,,"$2,250","$4,500","$3,750","$7,500","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180007","Select $5,500 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180007-01","Standard Bronze On Exchange Plan","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180005","Select $5,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180005-03","Limited Cost Sharing Plan Variation","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150006","Independence $1,500 -20% HDHP","38166WI015",,"WIN001","WIS001","WIF004","New","POS","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0150006-00","Standard Gold Off Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,250","$4,500","$3,750","$7,500",,,,,,,,,"30"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150009","Independence $4,000 - 20% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150009-00","Standard Bronze Off Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$9,000","$18,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$6,000","$12,000","$10,000","$20,000",,,,,,,,,"36"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150009","Independence $4,000 - 20% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150009-01","Standard Bronze On Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$9,000","$18,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$6,000","$12,000","$10,000","$20,000",,,,,,,,,"37"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180006","Select $6,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180006-03","Limited Cost Sharing Plan Variation","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170006-00","Standard Bronze Off Exchange Plan","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150010","Independence $3,350 - 40% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150010-00","Standard Bronze Off Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,775","$17,550","$15,125","$30,250",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"$5,025","$10,050","$8,375","$16,750",,,,,,,,,"38"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010059","Dean HSA 5000X","38345WI001",,"WIN001","WIS001","WIF003","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010059-01","Standard Bronze On Exchange Plan",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010060","Dean HSA 6250X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010060-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010060","Dean HSA 6250X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010060-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150006","Independence $1,500 -20% HDHP","38166WI015",,"WIN001","WIS001","WIF004","New","POS","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0150006-01","Standard Gold On Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$3,000","$6,000","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,250","$4,500","$3,750","$7,500",,,,,,,,,"31"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180003","Select $1,800 - 20%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $200 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180003-01","Standard Silver On Exchange Plan","71.90%","0.712650656700134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,800","$3,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150004","Independence - $1,500 - 30%","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150004-01","Standard Silver On Exchange Plan","70.03%","0.700253307819366","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,250","$20,500","$16,250","$32,500","$1,500","$3,000","30%",,,,"$2,250","$4,500","$3,750","$7,500","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-01","Standard Silver On Exchange Plan","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160010","Reliance $3,350 - 40% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160010-00","Standard Bronze Off Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180005","Select $5,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180005-01","Standard Bronze On Exchange Plan","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160010","Reliance $3,350 - 40% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160010-01","Standard Bronze On Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180005","Select $5,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-06","94% AV Level Silver Plan","93.07%","0.930677950382233","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-01","Standard Silver On Exchange Plan","69.68%","0.696805655956268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-03","Limited Cost Sharing Plan Variation","69.68%","0.696805655956268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-03","Limited Cost Sharing Plan Variation","70.00%","0.69080126285553","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-04","73% AV Level Silver Plan","73.30%","0.732791364192963","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-05","87% AV Level Silver Plan","87.90%","0.878813982009888","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","1","38166","WI","Individual","No","39-1572880","38166WI0180004","Select $2,000 - 30%","38166WI018",,"WIN002","WIS002","WIF002","New","EPO","Silver","Yes","Both","Yes","No",,"Additional copayments after deductible and coinsurance for the following items: Specialist Visit: $50 per visit to MOOP Emergency Room: $150 per visit to MOOP Hospital Inpatient: $500 per stay to MOOP MRI and CT Scans: $150 per day to MOOP","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180004-06","94% AV Level Silver Plan","93.30%","0.933220684528351","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - HDHP","38166WI014",,"WIN001","WIS001","WIF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140002-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-00","Standard Silver Off Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140002","Tradition $2,000 - HDHP","38166WI014",,"WIN001","WIS001","WIF006","New","HMO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140002-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140003","Tradition $1,500 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0140003-00","Standard Gold Off Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140003","Tradition $1,500 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF004","New","HMO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0140003-01","Standard Gold On Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140005","Tradition $1,750 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140005-00","Standard Silver Off Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-04","73% AV Level Silver Plan","73.73%","0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-05","87% AV Level Silver Plan","87.65%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140005","Tradition $1,750 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140005-01","Standard Silver On Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170002","Classic $3,000 HDHP","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170002-06","94% AV Level Silver Plan","94.49%","0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140008","Tradition $2,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140008-00","Standard Silver Off Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140008","Tradition $2,000 - 10% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140008-01","Standard Silver On Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170005","Classic $5,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170005-00","Standard Bronze Off Exchange Plan","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140009","Tradition $4,000 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140009-00","Standard Bronze Off Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170005","Classic $5,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170005-01","Standard Bronze On Exchange Plan","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170005","Classic $5,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140009","Tradition $4,000 - 20% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140009-01","Standard Bronze On Exchange Plan","61.40%","0.614021420478821","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140010","Tradition $3,350 - 40% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140010-00","Standard Bronze Off Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170005","Classic $5,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170005-03","Limited Cost Sharing Plan Variation","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0140010","Tradition $3,350 - 40% HDHP","38166WI014",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0140010-01","Standard Bronze On Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170007-00","Standard Bronze Off Exchange Plan","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - HDHP","38166WI016",,"WIN002","WIS002","WIF006","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160005-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170007-01","Standard Bronze On Exchange Plan","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160005","Reliance $2,000 - HDHP","38166WI016",,"WIN002","WIS002","WIF006","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160005-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170007","Classic $5,500 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170007-03","Limited Cost Sharing Plan Variation","59.39%","0.594647645950317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160006","Reliance $1,500 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0160006-00","Standard Gold Off Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160006","Reliance $1,500 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF004","New","EPO","Gold","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://www.securityhealth.org/formulary","38166WI0160006-01","Standard Gold On Exchange Plan","79.73%","0.797334671020508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-00","Standard Silver Off Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160007","Reliance $1,750 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160007-00","Standard Silver Off Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160007","Reliance $1,750 - 20% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160007-01","Standard Silver On Exchange Plan","68.63%","0.686293601989746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0160008","Reliance $2,000 - 10% HDHP","38166WI016",,"WIN002","WIS002","WIF003","New","EPO","Silver","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0160008-00","Standard Silver Off Exchange Plan","69.17%","0.691667020320892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-04","73% AV Level Silver Plan","73.73%","0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180002","Select $3,000 HDHP","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Silver","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180002-06","94% AV Level Silver Plan","94.49%","0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180005","Select $5,000 HDHP","38166WI018",,"WIN002","WIS002","WIF003","New","EPO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180005-00","Standard Bronze Off Exchange Plan","60.40%","0.604778349399567","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060008","Prevea360 Classic 4500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060008-06","94% AV Level Silver Plan","93.50%","0.935030460357666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010062","Dean Value 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010062","Dean Value 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010062-03","Limited Cost Sharing Plan Variation",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080001","Dean HSA Focus 5000X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080001-01","Standard Bronze On Exchange Plan",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080001","Dean HSA Focus 5000X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080001","Dean HSA Focus 5000X","38345WI008",,"WIN002","WIS002","WIF003","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080001-03","Limited Cost Sharing Plan Variation",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080002","Dean HSA Focus 6250X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080002-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080002","Dean HSA Focus 6250X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-06","94% AV Level Silver Plan","93.07%","0.930677950382233","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-01","Standard Silver On Exchange Plan","69.68%","0.696805655956268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-03","Limited Cost Sharing Plan Variation","69.68%","0.696805655956268","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-04","73% AV Level Silver Plan","73.62%","0.736194789409637","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-05","87% AV Level Silver Plan","86.49%","0.864901006221771","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010058","Dean Classic 4500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010058-06","94% AV Level Silver Plan","93.50%","0.935030460357666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0060007","Prevea360 Classic 3000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060007-01","Standard Silver On Exchange Plan","68.06%","0.680645763874054","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080003","Dean Value Focus 4000X","38345WI008",,"WIN002","WIS002","WIF004","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080003","Dean Value Focus 4000X","38345WI008",,"WIN002","WIS002","WIF004","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080003-03","Limited Cost Sharing Plan Variation",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080004","Dean Value Focus 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080004-01","Standard Bronze On Exchange Plan",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080004","Dean Value Focus 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080004","Dean Value Focus 6000X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080004-03","Limited Cost Sharing Plan Variation",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060009","Prevea360 HSA 5000X","38345WI006",,"WIN003","WIS003","WIF007","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060009-01","Standard Bronze On Exchange Plan",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060009","Prevea360 HSA 5000X","38345WI006",,"WIN003","WIS003","WIF007","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060009","Prevea360 HSA 5000X","38345WI006",,"WIN003","WIS003","WIF007","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060009-03","Limited Cost Sharing Plan Variation",,"0.602932214736938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060010","Prevea360 HSA 6250X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060010-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060010","Prevea360 HSA 6250X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060010","Prevea360 HSA 6250X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060010-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060011","Prevea360 Value 4000X","38345WI006",,"WIN003","WIS003","WIF008","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060011-01","Standard Bronze On Exchange Plan",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010060","Dean HSA 6250X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010060-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010061","Dean Value 4000X","38345WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010061-01","Standard Bronze On Exchange Plan",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010061","Dean Value 4000X","38345WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010061-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010061","Dean Value 4000X","38345WI001",,"WIN001","WIS001","WIF004","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010061-03","Limited Cost Sharing Plan Variation",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0010062","Dean Value 6000X","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010062-01","Standard Bronze On Exchange Plan",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","SHOP (Small Group)","No","39-1572880","38166WI0150010","Independence $3,350 - 40% HDHP","38166WI015",,"WIN001","WIS001","WIF003","New","POS","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Services with non-network providers apply to out of network cost sharing amounts, except for urgent and emergent care","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0150010-01","Standard Bronze On Exchange Plan","61.14%","0.611431956291199","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,775","$17,550","$15,125","$30,250",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","40%",,,,"$5,025","$10,050","$8,375","$16,750",,,,,,,,,"39"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170006-01","Standard Bronze On Exchange Plan","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170006","Classic $6,000 HDHP","38166WI017",,"WIN001","WIS001","WIF003","New","HMO","Bronze","Yes","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170006-03","Limited Cost Sharing Plan Variation","58.27%","0.582668662071228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170008","Classic $6,350","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"42"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0170008","Classic $6,350","38166WI017",,"WIN001","WIS001","WIF006","New","HMO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0170008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180008","Select $6,350","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","WI","38166","HIOS","5","2013-09-17 16:07:07","2","38166","WI","Individual","No","39-1572880","38166WI0180008","Select $6,350","38166WI018",,"WIN002","WIS002","WIF006","New","EPO","Catastrophic","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Urgent and Emergent Care Only","Yes","Urgent and Emergent Care Only","No","www.securityhealth.org","www.securityhealth.org/onlinepayment","www.securityhealth.org","http://securityhealth.org/formulary","38166WI0180008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010051","Dean Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010051-01","Standard Gold On Exchange Plan","79.93%","0.799323081970215","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010051","Dean Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010051-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010051","Dean Copay Plus 1000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010051-03","Limited Cost Sharing Plan Variation","79.93%","0.799323081970215","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-01","Standard Silver On Exchange Plan","71.67%","0.716674149036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-03","Limited Cost Sharing Plan Variation","71.67%","0.716674149036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-04","73% AV Level Silver Plan","73.72%","0.737166285514832","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-05","87% AV Level Silver Plan","86.29%","0.86294037103653","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010053","Dean Copay Plus 2000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010053-06","94% AV Level Silver Plan","93.25%","0.93252956867218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-01","Standard Silver On Exchange Plan","69.94%","0.699370920658112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-03","Limited Cost Sharing Plan Variation","69.94%","0.699370920658112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-04","73% AV Level Silver Plan","73.26%","0.732550382614136","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-05","87% AV Level Silver Plan","86.29%","0.86294037103653","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0010054","Dean Copay Plus 3500X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010054-06","94% AV Level Silver Plan","93.25%","0.93252956867218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060001","Prevea360 Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060001-01","Standard Gold On Exchange Plan","79.93%","0.799323081970215","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060001","Prevea360 Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060001","Prevea360 Copay Plus 1000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Gold","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060001-03","Limited Cost Sharing Plan Variation","79.93%","0.799323081970215","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-01","Standard Silver On Exchange Plan","71.67%","0.716674149036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-03","Limited Cost Sharing Plan Variation","71.67%","0.716674149036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-04","73% AV Level Silver Plan","73.72%","0.737166285514832","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-05","87% AV Level Silver Plan","86.29%","0.86294037103653","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060003","Prevea360 Copay Plus 2000X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060003-06","94% AV Level Silver Plan","93.25%","0.93252956867218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-01","Standard Silver On Exchange Plan","69.94%","0.699370920658112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-03","Limited Cost Sharing Plan Variation","69.94%","0.699370920658112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-04","73% AV Level Silver Plan","73.26%","0.732550382614136","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-05","87% AV Level Silver Plan","86.29%","0.86294037103653","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","1","38345","WI","Individual","No","39-1535024","38345WI0060004","Prevea360 Copay Plus 3500X","38345WI006",,"WIN003","WIS003","WIF005","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060004-06","94% AV Level Silver Plan","93.25%","0.93252956867218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-01","Standard Silver On Exchange Plan","68.06%","0.680645763874054","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-03","Limited Cost Sharing Plan Variation","68.06%","0.680645763874054","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-04","73% AV Level Silver Plan","73.75%","0.737509369850159","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","2","38345","WI","Individual","No","39-1535024","38345WI0010057","Dean Classic 3000X","38345WI001",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010057-05","87% AV Level Silver Plan","87.04%","0.870420694351196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080002","Dean HSA Focus 6250X","38345WI008",,"WIN002","WIS002","WIF002","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080002-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0080003","Dean Value Focus 4000X","38345WI008",,"WIN002","WIS002","WIF004","New","EPO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0080003-01","Standard Bronze On Exchange Plan",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060011","Prevea360 Value 4000X","38345WI006",,"WIN003","WIS003","WIF008","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"35"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060011","Prevea360 Value 4000X","38345WI006",,"WIN003","WIS003","WIF008","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060011-03","Limited Cost Sharing Plan Variation",,"0.615879237651825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060012","Prevea360 Value 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060012-01","Standard Bronze On Exchange Plan",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060012","Prevea360 Value 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"38"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","3","38345","WI","Individual","No","39-1535024","38345WI0060012","Prevea360 Value 6000X","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Bronze","No","On the Exchange","No","No",,"See policy or plan document for excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060012-03","Limited Cost Sharing Plan Variation",,"0.59146785736084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","4","38345","WI","Individual","No","39-1535024","38345WI0010063","Dean Safety Net","38345WI001",,"WIN001","WIS001","WIF002","New","HMO","Catastrophic","No","On the Exchange","No","No",,"Child-Only not allowed. See policy or plan document for additional excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.deancare.com/sbc/Individual.aspx","https://payment.deanhealthplan.com/payment.php","http://www.deancare.com/insurance/find-plan/individual-family/","http://www.deancare.com/insurance/members/drug-formulary/","38345WI0010063-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","38345","HIOS","10","2014-01-16 07:24:04","4","38345","WI","Individual","No","39-1535024","38345WI0060013","Prevea360 Safety Net","38345WI006",,"WIN003","WIS003","WIF006","New","HMO","Catastrophic","No","On the Exchange","No","No",,"Child-only not allowed. See policy or plan document for additional excluded services","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Emergency only","Yes","Emergency only","No","https://app.prevea360.com/sbc/Individual.aspx","https://payment.prevea360.com/payment.php","http://www.prevea360.com/Quote-Buy-Insurance/Individual-Family-Plans.aspx","http://www.prevea360.com/For-Members/Pharmacy-Benefits/Drug-Formulary.aspx","38345WI0060013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050001","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050001-00","Standard Gold Off Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060001-00","Standard Platinum Off Exchange Plan","90.60%","0.904491007328033","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050001","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050001-01","Standard Gold On Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060001","Platinum 1000","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060001-01","Standard Platinum On Exchange Plan","90.60%","0.904491007328033","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050001","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060002-00","Standard Platinum Off Exchange Plan","90.60%","0.904491007328033","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050001","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050001-03","Limited Cost Sharing Plan Variation","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060002","Platinum 1000","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060002-01","Standard Platinum On Exchange Plan","90.60%","0.904491007328033","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060003-00","Standard Gold Off Exchange Plan","81.60%","0.799413025379181","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050002","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050002-00","Standard Gold Off Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050002","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050002-01","Standard Gold On Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060003","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060003-01","Standard Gold On Exchange Plan","81.60%","0.799413025379181","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050002","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060004-00","Standard Gold Off Exchange Plan","81.60%","0.799413025379181","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050002","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050002-03","Limited Cost Sharing Plan Variation","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060004","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060004-01","Standard Gold On Exchange Plan","81.60%","0.799413025379181","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050021","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050021-00","Standard Gold Off Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060013-00","Standard Silver Off Exchange Plan","71.90%","0.683989346027374","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050021","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050021-01","Standard Gold On Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060013","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060013-01","Standard Silver On Exchange Plan","71.90%","0.683989346027374","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060014-00","Standard Silver Off Exchange Plan","71.90%","0.683989346027374","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050021","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050021-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060014","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060014-01","Standard Silver On Exchange Plan","71.90%","0.683989346027374","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050021","Gold HDHP 100","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050021-03","Limited Cost Sharing Plan Variation","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060023","Platinum 1000","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060023-00","Standard Platinum Off Exchange Plan","90.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","16"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-00","Standard Silver Off Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","16"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060023","Platinum 1000","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency & Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060023-01","Standard Platinum On Exchange Plan","90.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$0","$0","$0","$1,000","$0","$0","$0","17"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-01","Standard Silver On Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","17"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060024","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060024-00","Standard Gold Off Exchange Plan","81.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","18"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060024","Gold 1000/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060024-01","Standard Gold On Exchange Plan","81.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$560","$140","$0","19"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-03","Limited Cost Sharing Plan Variation","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","19"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-04","73% AV Level Silver Plan","73.70%","0.736745297908783","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$350","$0","$2,000","$0","$330","$0","20"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060025","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060025-00","Standard Silver Off Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","20"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-05","87% AV Level Silver Plan","87.70%","0.808071136474609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$0","$1,700","$0","$0","$0","21"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060025","Silver 2500/80 w/copay","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060025-01","Standard Silver On Exchange Plan","71.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,400","$70","$1,170","$0","$1,700","$560","$0","$0","21"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050011","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050011-06","94% AV Level Silver Plan","94.00%","0.909709393978119","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$0","$0","$0","$700","$0","$0","$0","22"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-00","Standard Silver Off Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","23"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-01","Standard Silver On Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","24"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"25"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-03","Limited Cost Sharing Plan Variation","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","26"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-04","73% AV Level Silver Plan","73.70%","0.736745297908783","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$350","$0","$2,000","$0","$330","$0","27"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-05","87% AV Level Silver Plan","87.70%","0.808071136474609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$0","$1,700","$0","$0","$0","28"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050012","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050012-06","94% AV Level Silver Plan","94.00%","0.909709393978119","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$0","$0","$0","$700","$0","$0","$0","29"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-00","Standard Silver Off Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","30"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-01","Standard Silver On Exchange Plan","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","31"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-03","Limited Cost Sharing Plan Variation","68.10%","0.678558886051178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$225","$0","$3,000","$0","$345","$0","33"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-04","73% AV Level Silver Plan","73.70%","0.736745297908783","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$350","$0","$2,000","$0","$330","$0","34"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-05","87% AV Level Silver Plan","87.70%","0.808071136474609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$0","$0","$0","$1,700","$0","$0","$0","35"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050022","Silver HDHP 85","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050022-06","94% AV Level Silver Plan","94.00%","0.909709393978119","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,400","$0","$0","$0","$700","$0","$0","$0","36"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050013-00","Standard Bronze Off Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","37"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050013-01","Standard Bronze On Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","38"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"39"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050013","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050013-03","Limited Cost Sharing Plan Variation","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","40"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050014-00","Standard Bronze Off Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","41"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050014-01","Standard Bronze On Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","42"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"43"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050014","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050014-03","Limited Cost Sharing Plan Variation","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","44"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050023","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050023-00","Standard Bronze Off Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","45"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050023","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050023-01","Standard Bronze On Exchange Plan","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","46"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050023","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050023-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"47"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050023","Bronze HDHP 100 Low","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050023-03","Limited Cost Sharing Plan Variation","62.00%","0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,250","$0","$0","$0","48"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050017-00","Standard Bronze Off Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","49"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050017-01","Standard Bronze On Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","50"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050017-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"51"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050017","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050017-03","Limited Cost Sharing Plan Variation","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","52"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050018-00","Standard Bronze Off Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","53"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050018-01","Standard Bronze On Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","54"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050018-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"55"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050018","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050018-03","Limited Cost Sharing Plan Variation","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","56"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050024","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050024-00","Standard Bronze Off Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","57"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050024","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050024-01","Standard Bronze On Exchange Plan","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","58"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050024","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"59"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050024","Bronze HDHP 100 High","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050024-03","Limited Cost Sharing Plan Variation","58.30%","0.583340167999268","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","60"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050019","Essential HDHP","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","61"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050019","Essential HDHP","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","62"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050020","Essential HDHP","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050020-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","63"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050020","Essential HDHP","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050020-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","64"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050025","Essential HDHP","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","65"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","1","47342","WI","Individual","No","39-1545987","47342WI0050025","Essential HDHP","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Catastrophic","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$5,300","$0","$0","$0","66"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060005-00","Standard Gold Off Exchange Plan","80.40%","0.781592786312103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050003-00","Standard Gold Off Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050003-01","Standard Gold On Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060005","Gold 1000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060005-01","Standard Gold On Exchange Plan","80.40%","0.781592786312103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060006-00","Standard Gold Off Exchange Plan","80.40%","0.781592786312103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060006","Gold 1000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060006-01","Standard Gold On Exchange Plan","80.40%","0.781592786312103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050003","Gold 1000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050003-03","Limited Cost Sharing Plan Variation","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050004-00","Standard Gold Off Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060009-00","Standard Silver Off Exchange Plan","69.20%","0.65583997964859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060009","Silver 2000/70","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060009-01","Standard Silver On Exchange Plan","69.20%","0.65583997964859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050004-01","Standard Gold On Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060010-00","Standard Silver Off Exchange Plan","69.20%","0.65583997964859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050004","Gold 1000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050004-03","Limited Cost Sharing Plan Variation","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060010","Silver 2000/70","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060010-01","Standard Silver On Exchange Plan","69.20%","0.65583997964859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060026","Gold 1000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060026-00","Standard Gold Off Exchange Plan","80.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050026","Gold 1000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050026-00","Standard Gold Off Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050026","Gold 1000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050026-01","Standard Gold On Exchange Plan","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060026","Gold 1000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060026-01","Standard Gold On Exchange Plan","80.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060027","Silver 2000/70","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060027-00","Standard Silver Off Exchange Plan","69.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050026","Gold 1000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050026-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060027","Silver 2000/70","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060027-01","Standard Silver On Exchange Plan","69.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$2,000","$435","$120","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050026","Gold 1000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050026-03","Limited Cost Sharing Plan Variation","78.60%","0.786036670207977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$70","$1,080","$0","$1,000","$435","$280","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-00","Standard Silver Off Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","16"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-01","Standard Silver On Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","17"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-03","Limited Cost Sharing Plan Variation","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","19"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-04","73% AV Level Silver Plan","73.60%","0.735657036304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$2,000","$435","$80","$0","20"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-05","87% AV Level Silver Plan","87.70%","0.838430881500244","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","21"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050007","Silver 2000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050007-06","94% AV Level Silver Plan","94.00%","0.917767584323883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","22"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-00","Standard Silver Off Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","23"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-01","Standard Silver On Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","24"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-03","Limited Cost Sharing Plan Variation","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","26"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-04","73% AV Level Silver Plan","73.60%","0.735657036304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$2,000","$435","$80","$0","27"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-05","87% AV Level Silver Plan","87.70%","0.838430881500244","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","28"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050008","Silver 2000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050008-06","94% AV Level Silver Plan","94.00%","0.917767584323883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","29"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-00","Standard Silver Off Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","30"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-01","Standard Silver On Exchange Plan","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","31"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-03","Limited Cost Sharing Plan Variation","71.10%","0.711262822151184","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$920","$0","$2,000","$435","$80","$0","33"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-04","73% AV Level Silver Plan","73.60%","0.735657036304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$2,000","$435","$80","$0","34"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-05","87% AV Level Silver Plan","87.70%","0.838430881500244","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","35"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050027","Silver 2000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050027-06","94% AV Level Silver Plan","94.00%","0.917767584323883","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","36"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050015-00","Standard Bronze Off Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","37"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050015-01","Standard Bronze On Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","38"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050015","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050015-03","Limited Cost Sharing Plan Variation","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","40"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050016-00","Standard Bronze Off Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","41"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050016-01","Standard Bronze On Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","42"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050016","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050016-03","Limited Cost Sharing Plan Variation","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","44"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050028","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050028-00","Standard Bronze Off Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","45"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050028","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050028-01","Standard Bronze On Exchange Plan","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","46"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050028","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","2","47342","WI","Individual","No","39-1545987","47342WI0050028","Bronze 6000/80","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050028-03","Limited Cost Sharing Plan Variation","59.50%","0.595393300056458","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$70","$80","$0","$2,400","$435","$0","$0","48"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060007","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060007-00","Standard Gold Off Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050005-00","Standard Gold Off Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050005-01","Standard Gold On Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060007","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060007-01","Standard Gold On Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060008","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060008-00","Standard Gold Off Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060008","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060008-01","Standard Gold On Exchange Plan","78.80%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050005","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050005-03","Limited Cost Sharing Plan Variation","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060015","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060015-00","Standard Silver Off Exchange Plan","68.60%","0.582809746265411","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050006-00","Standard Gold Off Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060015","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060015-01","Standard Silver On Exchange Plan","68.60%","0.582809746265411","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050006-01","Standard Gold On Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","9"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060016","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060016-00","Standard Silver Off Exchange Plan","68.60%","0.582809746265411","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050006","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050006-03","Limited Cost Sharing Plan Variation","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060016","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060016-01","Standard Silver On Exchange Plan","68.60%","0.582809746265411","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","11"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060017-00","Standard Silver Off Exchange Plan","68.10%","0.645182192325592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050029","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050029-00","Standard Gold Off Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","12"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050029","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050029-01","Standard Gold On Exchange Plan","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060017","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060017-01","Standard Silver On Exchange Plan","68.10%","0.645182192325592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","13"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060018-00","Standard Silver Off Exchange Plan","68.10%","0.645182192325592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050029","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050029","Gold 2000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050029-03","Limited Cost Sharing Plan Variation","78.20%","0.779457092285156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$70","$880","$0","$1,700","$560","$0","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060018","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060018-01","Standard Silver On Exchange Plan","68.10%","0.645182192325592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","15"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-00","Standard Silver Off Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","16"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060019","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060019-00","Standard Bronze Off Exchange Plan","60.20%","0.581243753433228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","16"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-01","Standard Silver On Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","17"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060019","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060019-01","Standard Bronze On Exchange Plan","60.20%","0.581243753433228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","17"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060020","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060020-00","Standard Bronze Off Exchange Plan","60.20%","0.581243753433228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","18"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-03","Limited Cost Sharing Plan Variation","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","19"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060020","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060020-01","Standard Bronze On Exchange Plan","60.20%","0.581243753433228","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","19"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060011-00","Standard Bronze Off Exchange Plan","59.60%","0.588744401931763","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","20"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-04","73% AV Level Silver Plan","73.90%","0.734983682632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$70","$680","$0","$1,700","$560","$0","$0","20"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-05","87% AV Level Silver Plan","87.70%","0.878807604312897","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","21"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060011","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060011-01","Standard Bronze On Exchange Plan","59.60%","0.588744401931763","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","21"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060012-00","Standard Bronze Off Exchange Plan","59.60%","0.588744401931763","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","22"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050009","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS001","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050009-06","94% AV Level Silver Plan","94.00%","0.938591420650482","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","22"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-00","Standard Silver Off Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","23"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060012","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060012-01","Standard Bronze On Exchange Plan","59.60%","0.588744401931763","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","23"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060028","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060028-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","24"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-01","Standard Silver On Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","24"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060028","Gold HDHP 100","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060028-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$0","$2,000","$0","$0","$0","25"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060029","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060029-00","Standard Silver Off Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","26"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-03","Limited Cost Sharing Plan Variation","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","26"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060029","Silver HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060029-01","Standard Silver On Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$2,000","$0","$660","$0","27"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-04","73% AV Level Silver Plan","73.90%","0.734983682632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$70","$680","$0","$1,700","$560","$0","$0","27"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060030","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060030-00","Standard Silver Off Exchange Plan","68.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","28"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-05","87% AV Level Silver Plan","87.70%","0.878807604312897","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","28"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060030","Silver HDHP 90","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060030-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$150","$0","$3,000","$0","$230","$0","29"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050010","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS002","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050010-06","94% AV Level Silver Plan","94.00%","0.938591420650482","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","29"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060031","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060031-00","Standard Bronze Off Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","30"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-00","Standard Silver Off Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","30"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-01","Standard Silver On Exchange Plan","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","31"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060031","Bronze HDHP 80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060031-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,500","$0","$160","$0","31"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060032","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060032-00","Standard Bronze Off Exchange Plan","59.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","32"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060032","Bronze HDHP 60","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060032-01","Standard Bronze On Exchange Plan","59.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,500","$0","$0","$0","$4,000","$0","$520","$0","33"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-03","Limited Cost Sharing Plan Variation","69.10%","0.687534689903259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,900","$70","$480","$0","$1,700","$560","$0","$0","33"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-04","73% AV Level Silver Plan","73.90%","0.734983682632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,900","$70","$680","$0","$1,700","$560","$0","$0","34"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-05","87% AV Level Silver Plan","87.70%","0.878807604312897","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$0","$1,700","$0","$0","$0","35"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","3","47342","WI","Individual","No","39-1545987","47342WI0050030","Silver 4000/80 w/copay","47342WI005","7720081950","WIN001","WIS003","WIF001","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care Only","Yes","Emergency and Urgent Care Only","No","www.healthtradition.com/coverage-summary-for-individuals","www.HealthTradition.com/go/paynow","www.healthtradition.com/brochures-for-individuals","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0050030-06","94% AV Level Silver Plan","94.00%","0.938591420650482","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,400","$0","$0","$0","$700","$0","$0","$0","36"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060021","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060021-00","Standard Bronze Off Exchange Plan","59.50%","0.609001159667969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","4"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060021","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060021-01","Standard Bronze On Exchange Plan","59.50%","0.609001159667969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","5"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060022","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060022-00","Standard Bronze Off Exchange Plan","59.50%","0.609001159667969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","6"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060022","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS002","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060022-01","Standard Bronze On Exchange Plan","59.50%","0.609001159667969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","7"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060033","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060033-00","Standard Bronze Off Exchange Plan","59.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","8"
"2014","WI","47342","HIOS","11","2014-07-25 16:54:18","4","47342","WI","SHOP (Small Group)","No","39-1545987","47342WI0060033","Bronze 6000/80","47342WI006","7720081950","WIN001","WIS003","WIF001","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent Care and Emergency Only","Yes","Emergency and Urgent Care only","No","http://www.healthtradition.com/coverage-summary-for-groups","www.HealthTradition.com/go/paynow","http://www.healthtradition.com/brochures-for-groups","http://www.healthtradition.com/go/members/drugs-pharmacy","47342WI0060033-01","Standard Bronze On Exchange Plan","59.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$6,900","$120","$80","$0","$2,400","$435","$0","$0","9"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","52697WI0010001-01","Standard Gold On Exchange Plan","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","52697WI0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","1","52697","WI","Individual","No","20-0813104","52697WI0010001","Molina Marketplace  Gold Plan","52697WI001",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/gold","52697WI0010001-03","Limited Cost Sharing Plan Variation","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-01","Standard Silver On Exchange Plan","69.10%","0.688628792762756","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$200","30%",,,,"Not Applicable","Not Applicable","$200","$200",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-03","Limited Cost Sharing Plan Variation","69.10%","0.688628792762756","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$200","30%",,,,"Not Applicable","Not Applicable","$200","$200",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-04","73% AV Level Silver Plan","73.60%","0.733477354049683","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$920","$180","$80","7"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-05","87% AV Level Silver Plan","87.80%","0.877585172653198","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$680","$320","$80","8"
"2014","WI","52697","HIOS","5","2013-10-15 07:27:56","2","52697","WI","Individual","No","20-0813104","52697WI0010002","Molina Marketplace  Silver Plan","52697WI001",,"WIN001","WIS001","WIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9944",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/plans/silver","52697WI0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070001","Medica Choice Passport WI 1300-20% HSA Gold","57637WI007",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070001-00","Standard Gold Off Exchange Plan",,"0.780426740646362","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$1,300","$0","$700","$1,000","$1,300","$0","$800","$0","4"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070001","Medica Choice Passport WI 1300-20% HSA Gold","57637WI007",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070001-01","Standard Gold On Exchange Plan",,"0.780426740646362","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,600","$5,200",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$1,300","$0","$700","$1,000","$1,300","$0","$800","$0","5"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070002","Medica Choice Passport WI 1750-25% HSA Silver","57637WI007",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070002-00","Standard Silver Off Exchange Plan",,"0.680849492549896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"$5,000","$9,900","Not Applicable","Not Applicable","$1,750","$0","$800","$1,000","$1,750","$0","$900","$0","6"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070002","Medica Choice Passport WI 1750-25% HSA Silver","57637WI007",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070002-01","Standard Silver On Exchange Plan",,"0.680849492549896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"$5,000","$9,900","Not Applicable","Not Applicable","$1,750","$0","$800","$1,000","$1,750","$0","$900","$0","7"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070003","Medica Choice Passport WI 4950-50% HSA Bronze","57637WI007",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070003-00","Standard Bronze Off Exchange Plan",,"0.583925843238831","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900","50%",,,,"$7,500","$9,900","Not Applicable","Not Applicable","$4,800","$0","$0","$1,000","$4,950","$0","$200","$0","8"
"2014","WI","57637","HIOS","5","2014-05-02 13:10:05","1","57637","WI","SHOP (Small Group)","No","41-1490988","57637WI0070003","Medica Choice Passport WI 4950-50% HSA Bronze","57637WI007",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services","Yes","Out-of-network benefits.","Yes","www.medica.com/SHOPPassportChoicePlusSBC",,"www.medica.com/SHOPPassportChoicePlusBrochure","www.medica.com/SHOPPharmacy","57637WI0070003-01","Standard Bronze On Exchange Plan",,"0.583925843238831","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,950","$9,900","50%",,,,"$7,500","$9,900","Not Applicable","Not Applicable","$4,800","$0","$0","$1,000","$4,950","$0","$200","$0","9"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010001","Medica Applause Gold Copay","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010001-00","Standard Gold Off Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010001","Medica Applause Gold Copay","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010001-01","Standard Gold On Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010001","Medica Applause Gold Copay","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010001","Medica Applause Gold Copay","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010002","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010001-03","Limited Cost Sharing Plan Variation",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010002","Medica Applause Gold Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010002-00","Standard Gold Off Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010002","Medica Applause Gold Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010002-01","Standard Gold On Exchange Plan",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010002","Medica Applause Gold Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010002","Medica Applause Gold Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010002-03","Limited Cost Sharing Plan Variation",,"0.784092128276825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$300","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-00","Standard Silver Off Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-01","Standard Silver On Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-03","Limited Cost Sharing Plan Variation",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-04","73% AV Level Silver Plan",,"0.720300376415253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,850","$5,550","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-05","87% AV Level Silver Plan",,"0.861329793930054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$600","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010003","Medica Applause Silver Copay","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010003-06","94% AV Level Silver Plan",,"0.931984722614288","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-00","Standard Silver Off Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-01","Standard Silver On Exchange Plan",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-03","Limited Cost Sharing Plan Variation",,"0.680687665939331","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$6,600","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-04","73% AV Level Silver Plan",,"0.720300376415253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,850","$5,550","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-05","87% AV Level Silver Plan",,"0.861329793930054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$600","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010004","Medica Applause Silver Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010004-06","94% AV Level Silver Plan",,"0.931984722614288","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010005","Medica Applause Bronze Copay","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010005-00","Standard Bronze Off Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010005","Medica Applause Bronze Copay","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010005-01","Standard Bronze On Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010005","Medica Applause Bronze Copay","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010005","Medica Applause Bronze Copay","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","57845WI0010006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010005-03","Limited Cost Sharing Plan Variation",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010006","Medica Applause Bronze Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010006-00","Standard Bronze Off Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010006","Medica Applause Bronze Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010006-01","Standard Bronze On Exchange Plan",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010006","Medica Applause Bronze Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","1","57845","WI","Individual","No","41-1843804","57845WI0010006","Medica Applause Bronze Copay (Child Only)","57845WI001",,"WIN001","WIS001","WIF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCopay","www.medica.com/IFBPharmacy","57845WI0010006-03","Limited Cost Sharing Plan Variation",,"0.618459045886993","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010007","Medica Applause Gold H S A","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010007-00","Standard Gold Off Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010007","Medica Applause Gold H S A","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010007-01","Standard Gold On Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010007","Medica Applause Gold H S A","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010007","Medica Applause Gold H S A","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010008","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010007-03","Limited Cost Sharing Plan Variation",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010008","Medica Applause Gold H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010008-00","Standard Gold Off Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010008","Medica Applause Gold H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010008-01","Standard Gold On Exchange Plan",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010008","Medica Applause Gold H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010008","Medica Applause Gold H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010008-03","Limited Cost Sharing Plan Variation",,"0.781114280223846","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,350","$7,050",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-00","Standard Silver Off Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-01","Standard Silver On Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-03","Limited Cost Sharing Plan Variation",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-04","73% AV Level Silver Plan",,"0.721749007701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-05","87% AV Level Silver Plan",,"0.862255096435547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010009","Medica Applause Silver H S A","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010010","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010009-06","94% AV Level Silver Plan",,"0.935520946979523","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$450","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-00","Standard Silver Off Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-01","Standard Silver On Exchange Plan",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-03","Limited Cost Sharing Plan Variation",,"0.680960297584534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,450","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$3,900","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-04","73% AV Level Silver Plan",,"0.721749007701874","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,050","$3,150","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-05","87% AV Level Silver Plan",,"0.862255096435547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$750","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010010","Medica Applause Silver H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010010-06","94% AV Level Silver Plan",,"0.935520946979523","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$450","5%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010011","Medica Applause Bronze H S A","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010011-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010011","Medica Applause Bronze H S A","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010011-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010011","Medica Applause Bronze H S A","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010011","Medica Applause Bronze H S A","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","57845WI0010012","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010011-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010012","Medica Applause Bronze H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010012-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010012","Medica Applause Bronze H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010012-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010012","Medica Applause Bronze H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","2","57845","WI","Individual","No","41-1843804","57845WI0010012","Medica Applause Bronze H S A (Child Only)","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseHSA","www.medica.com/IFBPharmacy","57845WI0010012-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","3","57845","WI","Individual","No","41-1843804","57845WI0010013","Medica Applause Catastrophic","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Catastrophic","No","Both","No","No",,"Medica’s catastrophic plan will be a full family plan (“adult only”), meaning an adult policyholder is required when a dependent child under age 21 is enrolled.  However “adult and child only” is selected due to the template’s error requiring a corresponding child-only plan with an adult-only offering.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCatastrophic","www.medica.com/IFBPharmacy","57845WI0010013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","4","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0040001","Guardian Family Advantage","69589WI004",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0040001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","4","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0060001","Guardian Family Essentials","69589WI006",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0060001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","4","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0060001","Guardian Family Essentials","69589WI006",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0060001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","1","79475","WI","Individual","No","39-1462554","79475WI0340006","Anthem Bronze DirectAccess w/Child Dental - cdbr","79475WI034",,"WIN002","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T2F","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340006-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","1","79475","WI","Individual","No","39-1462554","79475WI0340006","Anthem Bronze DirectAccess w/Child Dental - cdbr","79475WI034",,"WIN002","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T2F","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","1","79475","WI","Individual","No","39-1462554","79475WI0340006","Anthem Bronze DirectAccess w/Child Dental - cdbr","79475WI034",,"WIN002","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0T2F","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340006-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","2","79475","WI","Individual","No","39-1462554","79475WI0340012","Anthem Gold DirectAccess w/Child Dental - cdcp","79475WI034",,"WIN002","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SFA","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340012-01","Standard Gold On Exchange Plan","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090001","HMO CO 80 $2000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090001-01","Standard Gold On Exchange Plan","78.10%","0.781417906284332","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060007","HMO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060007-01","Standard Platinum On Exchange Plan","91.20%","0.911261379718781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090001","HMO CO 80 $2000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060009","HMO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060009-01","Standard Platinum On Exchange Plan","91.80%","0.918205797672272","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060011","HMO CO-80 $0 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060011-01","Standard Platinum On Exchange Plan","90.70%","0.906812846660614","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090001","HMO CO 80 $2000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090001-03","Limited Cost Sharing Plan Variation","78.10%","0.781417906284332","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270007","MyMeriter HDHP 4000","58564WI027","7477556600","WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270007-01","Standard Bronze On Exchange Plan","59.72%","0.597196757793427","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"19"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270007","MyMeriter HDHP 4000","58564WI027","7477556600","WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0010001","Guardian Pediatric Advantage","69589WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0010001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0010001","Guardian Pediatric Advantage","69589WI001",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0010001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0020001","Guardian Pediatric Essentials","69589WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0020001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","1","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0020001","Guardian Pediatric Essentials","69589WI002",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0020001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0030001","Guardian Family Advantage Plus","69589WI003",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0030001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","2","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0030001","Guardian Family Advantage Plus","69589WI003",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0030001-01","Standard High On Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","2","79475","WI","Individual","No","39-1462554","79475WI0340012","Anthem Gold DirectAccess w/Child Dental - cdcp","79475WI034",,"WIN002","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SFA","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","2","79475","WI","Individual","No","39-1462554","79475WI0340012","Anthem Gold DirectAccess w/Child Dental - cdcp","79475WI034",,"WIN002","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SFA","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340012-03","Limited Cost Sharing Plan Variation","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340001","Anthem Bronze DirectAccess - caaa","79475WI034",,"WIN001","WIS001","WIF015","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SE9","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340001-01","Standard Bronze On Exchange Plan","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340001","Anthem Bronze DirectAccess - caaa","79475WI034",,"WIN001","WIS001","WIF015","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SE9","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340001","Anthem Bronze DirectAccess - caaa","79475WI034",,"WIN001","WIS001","WIF015","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SE9","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340001-03","Limited Cost Sharing Plan Variation","61.80%","0.626193761825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340002","Anthem Bronze DirectAccess - caae","79475WI034",,"WIN001","WIS001","WIF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEB","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340002-01","Standard Bronze On Exchange Plan","60.43%","0.624035477638245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340002","Anthem Bronze DirectAccess - caae","79475WI034",,"WIN001","WIS001","WIF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEB","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","3","79475","WI","Individual","No","39-1462554","79475WI0340002","Anthem Bronze DirectAccess - caae","79475WI034",,"WIN001","WIS001","WIF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEB","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340002-03","Limited Cost Sharing Plan Variation","60.43%","0.624035477638245","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,050","$12,100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340004","Anthem Bronze DirectAccess w/HSA - cabp","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEF","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340004-01","Standard Bronze On Exchange Plan","61.13%","0.614655137062073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340004","Anthem Bronze DirectAccess w/HSA - cabp","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEF","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340004","Anthem Bronze DirectAccess w/HSA - cabp","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEF","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340004-03","Limited Cost Sharing Plan Variation","61.13%","0.614655137062073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270002","MyMeriter 1500","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270002-00","Standard Gold Off Exchange Plan","79.23%","0.792271614074707","No","No","No","100%",,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-04","73% AV Level Silver Plan","73.85%","0.738465964794159","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-05","87% AV Level Silver Plan","86.77%","0.867712914943695","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350014","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350014-00","Standard Silver Off Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","22"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","2","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0020002","Delta Dental PPOPediatric Oral Essential Health Benefit (POEHB) PlansLow Plan","79597WI002",,"WIN002","WIS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.37",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_Low_Summary.pdf","https://auth.deltadentalwi.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_Low_Brochure.pdf",,"79597WI0020002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","2","79597","WI","Individual","Yes","39-6094742","79597WI0010002","Delta Dental Pediatric Low","79597WI001",,"WIN001","WIS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_Low_Summary.pdf","https://auth.deltadentalcoversme.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_Low_Brochure.pdf",,"79597WI0010002-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","2","58326","WI","Individual","No","20-1482553","58326WI0090006","HMO CO 70 HDHP $5000 Deductible","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090006-03","Limited Cost Sharing Plan Variation","59.00%","0.590863168239594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","3","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0050001","Guardian Family Essentials Plus","69589WI005",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0050001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","3","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0050001","Guardian Family Essentials Plus","69589WI005",,"WIN001","WIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0050001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","69589","HIOS","4","2013-09-02 11:39:25","4","69589","WI","SHOP (Small Group)","Yes","13-5123390","69589WI0040001","Guardian Family Advantage","69589WI004",,"WIN001","WIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"69589WI0040001-00","Standard High Off Exchange Plan","85.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060013","HMO CO-90 $500 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060013-01","Standard Platinum On Exchange Plan","88.60%","0.885846078395844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-01","Standard Silver On Exchange Plan","69.80%","0.699589669704437","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","2","79597","WI","Individual","Yes","39-6094742","79597WI0010002","Delta Dental Pediatric Low","79597WI001",,"WIN001","WIS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_Low_Summary.pdf","https://auth.deltadentalcoversme.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_Low_Brochure.pdf",,"79597WI0010002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","35"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","36"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270001","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270001-00","Standard Platinum Off Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","37"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270002","MyMeriter 1500","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270002-01","Standard Gold On Exchange Plan","79.23%","0.792271614074707","No","No","No","100%",,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270002","MyMeriter 1500","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270002","MyMeriter 1500","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270002-03","Limited Cost Sharing Plan Variation","79.23%","0.792271614074707","No","No","No","100%",,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-06","94% AV Level Silver Plan","93.06%","0.930570304393768","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","$500","Not Applicable",,,,,,,,,"$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350005","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350005-00","Standard Gold Off Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250007","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350005","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350005-01","Standard Gold On Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","15"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250010","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","14"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070003","EPO CO-90 $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070003-01","Standard Platinum On Exchange Plan","91.80%","0.918205797672272","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070005","EPO CO-80 $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070005-01","Standard Platinum On Exchange Plan","90.70%","0.906812846660614","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070007","EPO CO-90 $500 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070007-01","Standard Platinum On Exchange Plan","88.60%","0.885846078395844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070009","EPO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070009-01","Standard Platinum On Exchange Plan","88.30%","0.883324921131134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070011","EPO CO-80 $1,250 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070011-01","Standard Gold On Exchange Plan","82.00%","0.819543838500977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070013","EPO CO-80 $2,000 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070013-01","Standard Gold On Exchange Plan","79.00%","0.789688766002655","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","57845","HIOS","3","2013-09-02 11:39:25","3","57845","WI","Individual","No","41-1843804","57845WI0010013","Medica Applause Catastrophic","57845WI001",,"WIN001","WIS001","WIF006","New","PPO","Catastrophic","No","Both","No","No",,"Medica’s catastrophic plan will be a full family plan (“adult only”), meaning an adult policyholder is required when a dependent child under age 21 is enrolled.  However “adult and child only” is selected due to the template’s error requiring a corresponding child-only plan with an adult-only offering.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Services","Yes","Out of Network Benefits","No","https://portal.medica.com/visitor/sbcsearch","www.medica.com/firstmonthpayment","www.medica.com/WI_ApplauseCatastrophic","www.medica.com/IFBPharmacy","57845WI0010013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070002","EPO CO-90 $0 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070002-01","Standard Platinum On Exchange Plan","91.20%","0.911613583564758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070004","EPO CO-80 $0 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070004-01","Standard Platinum On Exchange Plan","91.10%","0.91082102060318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070010","EPO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070010-01","Standard Gold On Exchange Plan","82.00%","0.819661915302277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070012","EPO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070012-01","Standard Gold On Exchange Plan","78.10%","0.781417906284332","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070014","EPO CO-60 $2,000 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070014-01","Standard Silver On Exchange Plan","71.80%","0.718991279602051","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070015","EPO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070015-01","Standard Silver On Exchange Plan","71.50%","0.715985298156738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060022","HMO CO-70 $2,500 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060022-01","Standard Silver On Exchange Plan","71.50%","0.715985298156738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","2","58326","WI","Individual","No","20-1482553","58326WI0090006","HMO CO 70 HDHP $5000 Deductible","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090006-01","Standard Bronze On Exchange Plan","59.00%","0.590863168239594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070006","EPO CO-90 $500 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070006-01","Standard Platinum On Exchange Plan","89.10%","0.89080798625946","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070008","EPO CO-80 $500 Deductible; $20/$40/$60 Rx","58326WI007",,"WIN002","WIS001","WIF001","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070008-01","Standard Platinum On Exchange Plan","89.50%","0.895487368106842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270007","MyMeriter HDHP 4000","58564WI027","7477556600","WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270007-03","Limited Cost Sharing Plan Variation","59.72%","0.597196757793427","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"21"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270014","MyMeriter Basic Plan","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","3","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterBasic.pdf",,"http://www.pplus.com/documents/upload/MyMeriterBasic.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270005","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270005-00","Standard Gold Off Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","41"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270005","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270005-01","Standard Gold On Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","42"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-03","Limited Cost Sharing Plan Variation","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-04","73% AV Level Silver Plan","72.10%","0.783713340759277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","0","30","1150","1970","0","0","20"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350013","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350013.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350013-00","Standard Silver Off Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","20"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","21"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350013","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350013.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350013-01","Standard Silver On Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","21"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-00","Standard Silver Off Exchange Plan","71.84%","0.71837329864502","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-01","Standard Silver On Exchange Plan","71.84%","0.71837329864502","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270003","MyMeriter 2000","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplusic.com/documents/upload/MyMeriter2000.pdf",,"http://www.pplusic.com/documents/upload/MyMeriter2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270003-03","Limited Cost Sharing Plan Variation","71.84%","0.71837329864502","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,350","$4,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060015","HMO CO-80 $500 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060015-01","Standard Platinum On Exchange Plan","88.30%","0.883324921131134","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-03","Limited Cost Sharing Plan Variation","69.80%","0.699589669704437","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060017","HMO CO-80 $1,250 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060017-01","Standard Gold On Exchange Plan","82.00%","0.819543838500977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-04","73% AV Level Silver Plan","73.80%","0.738004446029663","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060019","HMO CO-80 $2,000 Deductible; $10/$25/$50 Rx","58326WI006",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060019-01","Standard Gold On Exchange Plan","79.00%","0.789688766002655","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060008","HMO CO-90 $0 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060008-01","Standard Platinum On Exchange Plan","91.20%","0.911613583564758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-05","87% AV Level Silver Plan","86.30%","0.862725377082825","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","Individual","No","20-1482553","58326WI0090002","HMO CO 70 $5000 Deductible; $20/$40/$60 Rx","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090002-06","94% AV Level Silver Plan","93.00%","0.932711005210876","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060010","HMO CO-80 $0 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060010-01","Standard Platinum On Exchange Plan","91.10%","0.91082102060318","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060012","HMO CO-90 $500 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060012-01","Standard Platinum On Exchange Plan","89.10%","0.89080798625946","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060014","HMO CO-80 $500 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060014-01","Standard Platinum On Exchange Plan","89.50%","0.895487368106842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060016","HMO CO-80 $1,250 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060016-01","Standard Gold On Exchange Plan","82.00%","0.819661915302277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060018","HMO CO-80 $2,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060018-01","Standard Gold On Exchange Plan","78.10%","0.781417906284332","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060021","HMO CO-60 $2,000 Deductible; $20/$40/$60 Rx","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060021-01","Standard Silver On Exchange Plan","71.80%","0.718991279602051","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","1","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0070001","EPO Full Pay $0 Deductible; $10/$25/$50 Rx","58326WI007",,"WIN002","WIS001","WIF002","New","EPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0070001-01","Standard Platinum On Exchange Plan","91.20%","0.911261379718781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","2","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060024","HMO CO-60 HDHP $3200 Deductible","58326WI006",,"WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060024-01","Standard Bronze On Exchange Plan","61.69%","0.616851806640625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","2","58326","WI","Individual","No","20-1482553","58326WI0090006","HMO CO 70 HDHP $5000 Deductible","58326WI009",,"WIN001","WIS001","WIF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Limited to emergency services only","No","Limited to emergency services only","No","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/pay","http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0090006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WI","58326","HIOS","4","2014-01-21 08:29:49","2","58326","WI","SHOP (Small Group)","No","20-1482553","58326WI0060020","HMO H.S.A. $1,800 Deductible","58326WI006",,"WIN001","WIS001","WIF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","No","Out of Country Coverage for Emergency Services Only","No","Out of Service Area Coverage for Emergency Services Only","No","http://www.mercycarehealthplans.com",,"http://www.mercycarehealthplans.com","http://www.mercycarehealthplans.com/index.asp?menuID=202&firstlevelmenuID=140&siteID=1","58326WI0060020-01","Standard Gold On Exchange Plan","80.40%","0.803948640823364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-03","Limited Cost Sharing Plan Variation","70.30%","0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-04","73% AV Level Silver Plan","72.33%","0.723338723182678","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-05","87% AV Level Silver Plan","86.09%","0.86085969209671","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-06","94% AV Level Silver Plan","93.26%","0.932569682598114","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340011","Anthem Gold DirectAccess - ccab","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF8","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340011-01","Standard Gold On Exchange Plan","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340011","Anthem Gold DirectAccess - ccab","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF8","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340011","Anthem Gold DirectAccess - ccab","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF8","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340011-03","Limited Cost Sharing Plan Variation","78.11%","0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","7","79475","WI","Individual","No","39-1462554","79475WI0340013","Anthem Catastrophic DirectAccess","79475WI034",,"WIN001","WIS001","WIF003","New","POS","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SE7","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","8","79475","WI","Individual","No","39-1462554","79475WI0340005","Anthem Bronze DirectAccess - cabr","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEH","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340005-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","8","79475","WI","Individual","No","39-1462554","79475WI0340005","Anthem Bronze DirectAccess - cabr","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEH","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","8","79475","WI","Individual","No","39-1462554","79475WI0340005","Anthem Bronze DirectAccess - cabr","79475WI034",,"WIN001","WIS001","WIF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEH","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340005-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","1","79597","WI","Individual","Yes","39-6094742","79597WI0010001","Delta Dental Pediatric High","79597WI001",,"WIN001","WIS001",,"New","EPO","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$51.50",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_High_Summary.pdf","https://auth.deltadentalcoversme.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_High_Brochure.pdf",,"79597WI0010001-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270001","MyMeriter 1000","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1000.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270001-00","Standard Gold Off Exchange Plan","80.63%","0.806263744831085","No","No","No","100%",,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270001","MyMeriter 1000","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1000.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270001-01","Standard Gold On Exchange Plan","80.63%","0.806263744831085","No","No","No","100%",,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270001","MyMeriter 1000","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1000.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270001","MyMeriter 1000","58564WI027","7477556600","WIN001","WIS001","WIF001","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter1000.pdf",,"http://www.pplus.com/documents/upload/MyMeriter1000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270001-03","Limited Cost Sharing Plan Variation","80.63%","0.806263744831085","No","No","No","100%",,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-03","Limited Cost Sharing Plan Variation","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-04","73% AV Level Silver Plan","73.39%","0.738157749176025","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-05","87% AV Level Silver Plan","86.13%","0.862549245357513","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-06","94% AV Level Silver Plan","93.08%","0.931559145450592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340003","Anthem Bronze DirectAccess w/HSA - caar","79475WI034",,"WIN001","WIS001","WIF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SED","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340003-01","Standard Bronze On Exchange Plan",,"0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340003","Anthem Bronze DirectAccess w/HSA - caar","79475WI034",,"WIN001","WIS001","WIF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SED","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340003","Anthem Bronze DirectAccess w/HSA - caar","79475WI034",,"WIN001","WIS001","WIF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SED","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340003-03","Limited Cost Sharing Plan Variation",,"0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-00","Standard Silver Off Exchange Plan","70.68%","0.706794083118439","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,350","$2,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,500","$5,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-01","Standard Silver On Exchange Plan","70.68%","0.706794083118439","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,350","$2,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,500","$5,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-03","Limited Cost Sharing Plan Variation","70.68%","0.706794083118439","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,350","$2,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,500","$5,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-04","73% AV Level Silver Plan","73.85%","0.738465964794159","No","No","No","100%",,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-05","87% AV Level Silver Plan","86.77%","0.867712914943695","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","1","58564","WI","Individual","No","39-1565691","58564WI0270004","MyMeriter 2500","58564WI027","7477556600","WIN001","WIS001","WIF002","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,"$1,200","0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriter2500.pdf",,"http://www.pplus.com/documents/upload/MyMeriter2500.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270004-06","94% AV Level Silver Plan","93.69%","0.936888992786407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270005","MyMeriter HDHP 2000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270005-00","Standard Gold Off Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"7"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270005","MyMeriter HDHP 2000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270005-01","Standard Gold On Exchange Plan","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"8"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270005","MyMeriter HDHP 2000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"9"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270005","MyMeriter HDHP 2000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Gold","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP2000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270005-03","Limited Cost Sharing Plan Variation","78.81%","0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"10"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-00","Standard Silver Off Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"11"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"12"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"14"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-04","73% AV Level Silver Plan","73.89%","0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"Not Applicable","Not Applicable","$2,650","$5,300",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"Not Applicable","Not Applicable","$2,650","$5,300",,,,,,,,,"15"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-05","87% AV Level Silver Plan","87.75%","0.877534210681915","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,"16"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270006","MyMeriter HDHP 3000","58564WI027","7477556600","WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP3000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270006-06","94% AV Level Silver Plan","94.49%","0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","$400","$800",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","$400","$800",,,,,,,,,"17"
"2014","WI","58564","HIOS","8","2014-01-17 09:36:20","2","58564","WI","Individual","No","39-1565691","58564WI0270007","MyMeriter HDHP 4000","58564WI027","7477556600","WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","All specialty care outside the Meriter Health System, except for the services of obstetricians and gynocologists, requires prior authorization",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management",,"1",,,"0","0","0","2014-01-01",,"No",,"Yes","Highly specialized or tertiary care with prior authorization of the plan.  Emergency care needed while the member is out of the service area.","No","http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf",,"http://www.pplus.com/documents/upload/MyMeriterHDHP4000.pdf","http://www.pplusic.com/documents/upload/p6129-exchangeformulary.pdf","58564WI0270007-00","Standard Bronze Off Exchange Plan","59.72%","0.597196757793427","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"18"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-01","Standard Silver On Exchange Plan","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-03","Limited Cost Sharing Plan Variation","70.35%","0.710407257080078","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-04","73% AV Level Silver Plan","72.75%","0.732995271682739","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-05","87% AV Level Silver Plan","86.32%","0.865209221839905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340009","Anthem Silver DirectAccess - cbds","79475WI034",,"WIN001","WIS001","WIF001","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEY","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340009-06","94% AV Level Silver Plan","93.23%","0.933509588241577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-01","Standard Silver On Exchange Plan","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","4","79475","WI","Individual","No","39-1462554","79475WI0340008","Anthem Silver DirectAccess - cbjc","79475WI034",,"WIN001","WIS001","WIF008","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SES","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-01","Standard Silver On Exchange Plan","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-03","Limited Cost Sharing Plan Variation","69.15%","0.693959951400757","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-04","73% AV Level Silver Plan","72.80%","0.731756865978241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-05","87% AV Level Silver Plan","86.17%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","5","79475","WI","Individual","No","39-1462554","79475WI0340010","Anthem Silver DirectAccess w/HSA - cbbg","79475WI034",,"WIN001","WIS001","WIF013","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SF3","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340010-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-01","Standard Silver On Exchange Plan","70.30%","0.70304149389267","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","HIOS","10","2013-11-23 14:44:18","6","79475","WI","Individual","No","39-1462554","79475WI0340007","Anthem Silver DirectAccess - cbaa","79475WI034",,"WIN001","WIS001","WIF005","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SEM","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0340007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","1","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0020001","Delta Dental PPOPediatric Oral Essential Health Benefit (POEHB) PlansHigh Plan","79597WI002",,"WIN002","WIS001",,"New","EPO","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$38.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_High_Summary.pdf","https://auth.deltadentalwi.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_High_Brochure.pdf",,"79597WI0020001-00","Standard High Off Exchange Plan","86.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","1","79597","WI","Individual","Yes","39-6094742","79597WI0010001","Delta Dental Pediatric High","79597WI001",,"WIN001","WIS001",,"New","EPO","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$51.50",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_High_Summary.pdf","https://auth.deltadentalcoversme.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_Pediatric_High_Brochure.pdf",,"79597WI0010001-01","Standard High On Exchange Plan","86.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250005","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330011","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330011.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330011-01","Standard Silver On Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250004","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250004-03","Limited Cost Sharing Plan Variation","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330010","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330010-00","Standard Gold Off Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250008","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250008-00","Standard Gold Off Exchange Plan","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330010","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330010-01","Standard Gold On Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250008","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250008-01","Standard Gold On Exchange Plan","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330013","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330013.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330013-00","Standard Silver Off Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250008","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250008","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250008-03","Limited Cost Sharing Plan Variation","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330013","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330013.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330013-01","Standard Silver On Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330014","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330014-00","Standard Silver Off Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250010","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250010-00","Standard Gold Off Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330014","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330014-01","Standard Silver On Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330007","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330007-01","Standard Gold On Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330011","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330011.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330011-00","Standard Silver Off Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350001","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350001-00","Standard Platinum Off Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"500","70","0","30","140","1110","0","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350001","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350001-01","Standard Platinum On Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"500","70","0","30","140","1110","0","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250007","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250007-01","Standard Gold On Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350004","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350004-01","Standard Platinum On Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","15"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","1","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0020001","Delta Dental PPOPediatric Oral Essential Health Benefit (POEHB) PlansHigh Plan","79597WI002",,"WIN002","WIS001",,"New","EPO","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$38.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_High_Summary.pdf","https://auth.deltadentalwi.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_High_Brochure.pdf",,"79597WI0020001-01","Standard High On Exchange Plan","86.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250001","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250001-01","Standard Platinum On Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330005","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330005-00","Standard Gold Off Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$3,000","$6,000","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250001","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330005","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330005-01","Standard Gold On Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","$3,000","$6,000","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250001","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250001-03","Limited Cost Sharing Plan Variation","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250005","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250005-00","Standard Gold Off Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330007","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330007-00","Standard Gold Off Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250005","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250005-01","Standard Gold On Exchange Plan","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250005","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250005-03","Limited Cost Sharing Plan Variation","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250007","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250007-00","Standard Gold Off Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250007","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250007-03","Limited Cost Sharing Plan Variation","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","15"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-00","Standard Silver Off Exchange Plan","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-00","Standard Silver Off Exchange Plan","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350008","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350008-01","Standard Gold On Exchange Plan","79.80%","0.828196048736572","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270001","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270001-01","Standard Platinum On Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","38"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270001","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","39"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350007","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350007-00","Standard Gold Off Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-01","Standard Silver On Exchange Plan","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350007","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350007-01","Standard Gold On Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330019","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330019.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330019-01","Standard Bronze On Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350015","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350015-00","Standard Bronze Off Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350015","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350015-01","Standard Bronze On Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","15"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350016","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350016.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350016-00","Standard Gold Off Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270026","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","85"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270026","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270026-03","Limited Cost Sharing Plan Variation","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","86"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270004","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270004-01","Standard Platinum On Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","45"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270004","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","46"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270004","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270004-03","Limited Cost Sharing Plan Variation","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","47"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270008","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270008-00","Standard Gold Off Exchange Plan","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","48"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270001","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270001-03","Limited Cost Sharing Plan Variation","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","40"
"2014","WI","79597","HIOS","4","2013-09-10 14:43:20","2","79597","WI","SHOP (Small Group)","Yes","39-6094742","79597WI0020002","Delta Dental PPOPediatric Oral Essential Health Benefit (POEHB) PlansLow Plan","79597WI002",,"WIN002","WIS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.37",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_Low_Summary.pdf","https://auth.deltadentalwi.com/sp/ACS.saml2","https://www.deltadentalwi.com/assets/docs/ACA_Exchange/WI_POEHB_Low_Brochure.pdf",,"79597WI0020002-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","1","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0120001","EHB Basic Dental Plan (Low)","81335WI012","7326041556","WIN001","WIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.72",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48063",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48062",,"81335WI0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270007","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","47"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270007","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270007-03","Limited Cost Sharing Plan Variation","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","48"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-00","Standard Silver Off Exchange Plan","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","49"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-01","Standard Silver On Exchange Plan","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","50"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-04","73% AV Level Silver Plan","73.70%","0.79856675863266","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1610","0","0","27"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","28"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","29"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-00","Standard Silver Off Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","30"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","1","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0120001","EHB Basic Dental Plan (Low)","81335WI012","7326041556","WIN001","WIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.72",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48063",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48062",,"81335WI0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","2","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0130001","EHB Enhanced Dental Plan (High)","81335WI013","7326041556","WIN002","WIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$26.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49136",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49135",,"81335WI0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","2","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0130001","EHB Enhanced Dental Plan (High)","81335WI013","7326041556","WIN002","WIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$26.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49136",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49135",,"81335WI0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","25"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-03","Limited Cost Sharing Plan Variation","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","26"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","27"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","28"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","29"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-00","Standard Silver Off Exchange Plan","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","30"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-01","Standard Silver On Exchange Plan","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","31"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","32"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-03","Limited Cost Sharing Plan Variation","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","33"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250015","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250015-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","34"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270005","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","43"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270005","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270005.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270005-03","Limited Cost Sharing Plan Variation","79.20%","0.80521148443222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","90","0","30","140","1810","0","0","44"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","3","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)*","81335WI014","7326041556","WIN003","WIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.72",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138",,"81335WI0140001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","3","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0140001","Family Basic Dental Plan (Low)*","81335WI014","7326041556","WIN003","WIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.72",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49139",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49138",,"81335WI0140001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","4","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015","7326041556","WIN004","WIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$26.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140",,"81335WI0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","81335","HIOS","7","2013-10-15 07:27:56","4","81335","WI","SHOP (Small Group)","Yes","13-5581829","81335WI0150001","Family Enhanced Dental Plan (High)","81335WI015","7326041556","WIN004","WIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$26.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49141",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49140",,"81335WI0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330001","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330001-00","Standard Platinum Off Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"500","70","0","30","140","1110","0","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250001","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250001-00","Standard Platinum Off Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","1110","0","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330001","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330001.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330001-01","Standard Platinum On Exchange Plan","88.90%","0.906313478946686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"500","70","0","30","140","1110","0","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","51"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-00","Standard Silver Off Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","52"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-01","Standard Silver On Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","53"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","54"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-03","Limited Cost Sharing Plan Variation","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","55"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-04","73% AV Level Silver Plan","74.00%","0.739748239517212","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","56"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250024","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250024-03","Limited Cost Sharing Plan Variation","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250025","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250025-00","Standard Bronze Off Exchange Plan","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350011","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350011.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350011-00","Standard Silver Off Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350011","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350011.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350011-01","Standard Silver On Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-03","Limited Cost Sharing Plan Variation","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","20"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","21"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250012","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250012-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-00","Standard Silver Off Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","23"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1250014","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250014-01","Standard Silver On Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","24"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270007","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270007-00","Standard Gold Off Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","45"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270007","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270007.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270007-01","Standard Gold On Exchange Plan","81.70%","0.816034376621246","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1900","90","1100","30","140","1810","0","0","46"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","51"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-03","Limited Cost Sharing Plan Variation","70.00%","0.704830527305603","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3900","110","320","30","140","2210","0","0","52"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","53"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","54"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270012","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270012.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270012-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","55"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-00","Standard Silver Off Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","56"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-01","Standard Silver On Exchange Plan","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","57"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","58"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350014","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350014-01","Standard Silver On Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","23"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-03","Limited Cost Sharing Plan Variation","71.30%","0.718859732151031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","110","830","30","140","2210","0","0","59"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","60"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","61"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270014","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270014.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270014-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","62"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-00","Standard Silver Off Exchange Plan","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","63"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-01","Standard Silver On Exchange Plan","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","64"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","65"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-03","Limited Cost Sharing Plan Variation","68.10%","0.682753682136536","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable","$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"5400","110","500","30","140","2210","0","0","66"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-04","73% AV Level Silver Plan","73.40%","0.774064540863037","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","110","0","30","140","2210","0","0","67"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-05","87% AV Level Silver Plan","86.60%","0.881369292736053","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","90","0","30","140","1360","0","0","68"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","1","84670","WI","Individual","No","20-2660193","84670WI1270015","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270015-06","94% AV Level Silver Plan","93.70%","0.947873950004578","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","70","0","30","140","360","0","0","69"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330004","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330004-00","Standard Platinum Off Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250004","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250004-00","Standard Platinum Off Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250004","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250004-01","Standard Platinum On Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330004","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330004-01","Standard Platinum On Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330008","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330008-00","Standard Gold Off Exchange Plan","79.80%","0.828196048736572","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250004","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF001","New","HMO","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330008","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330008-01","Standard Gold On Exchange Plan","79.80%","0.828196048736572","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250010","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250010-01","Standard Gold On Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350004","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350004-00","Standard Platinum Off Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250010","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF002","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250010-03","Limited Cost Sharing Plan Variation","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","15"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350008","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350008-00","Standard Gold Off Exchange Plan","79.80%","0.828196048736572","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270028","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270028-00","Standard Gold Off Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","91"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270028","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270028-01","Standard Gold On Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","92"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270026","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270026-00","Standard Bronze Off Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","83"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270026","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270026-01","Standard Bronze On Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","84"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270010","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270010-03","Limited Cost Sharing Plan Variation","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","55"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-00","Standard Silver Off Exchange Plan","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","56"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-01","Standard Silver On Exchange Plan","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","57"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","58"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250027","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250027-03","Limited Cost Sharing Plan Variation","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250028","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250028-00","Standard Gold Off Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","20"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250028","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250028-01","Standard Gold On Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","21"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250028","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270008","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270008-01","Standard Gold On Exchange Plan","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","49"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270008","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","50"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270008","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270008.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270008-03","Limited Cost Sharing Plan Variation","79.80%","0.823169350624084","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1350","0","0","51"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270010","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270010-00","Standard Gold Off Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","52"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-03","Limited Cost Sharing Plan Variation","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","59"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-04","73% AV Level Silver Plan","72.10%","0.783713340759277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","0","30","1150","1970","0","0","60"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","61"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270017","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270017-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","62"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","37"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-00","Standard Silver Off Exchange Plan","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","38"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-01","Standard Silver On Exchange Plan","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","39"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","40"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-03","Limited Cost Sharing Plan Variation","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","41"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-04","73% AV Level Silver Plan","72.90%","0.729270815849304","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","42"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","43"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250031","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250031-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","44"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270010","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270010-01","Standard Gold On Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","53"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270010","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","54"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-01","Standard Silver On Exchange Plan","68.70%","0.699668288230896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"4900","80","0","30","1150","1970","0","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250017","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350010","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350010-00","Standard Gold Off Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350010","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF002","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350010.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350010-01","Standard Gold On Exchange Plan","81.20%","0.812380015850067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","1420","30","500","1610","130","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-00","Standard Silver Off Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","23"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-01","Standard Silver On Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","24"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","25"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250020","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250020-03","Limited Cost Sharing Plan Variation","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","26"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-03","Limited Cost Sharing Plan Variation","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","73"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-04","73% AV Level Silver Plan","73.30%","0.797469079494476","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1610","0","0","74"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","29"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","30"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-00","Standard Silver Off Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","31"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","32"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","33"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","34"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-01","Standard Silver On Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","31"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","32"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-03","Limited Cost Sharing Plan Variation","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","33"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-04","73% AV Level Silver Plan","73.30%","0.797469079494476","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1610","0","0","34"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","35"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250021","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250021-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","36"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-00","Standard Silver Off Exchange Plan","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","37"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-01","Standard Silver On Exchange Plan","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","38"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"0","0","0","0","0","0","0","0","39"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-03","Limited Cost Sharing Plan Variation","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","40"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-04","73% AV Level Silver Plan","72.10%","0.783713340759277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","0","30","1150","1970","0","0","41"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","42"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1250022","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF003","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250022-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","43"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270004","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF001","New","POS","Platinum","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127000401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270004.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270004-00","Standard Platinum Off Exchange Plan","88.20%","0.881754577159882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","0","750","30","140","1110","0","0","44"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350018","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350018.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350018-01","Standard Bronze On Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","21"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350019","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350019.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350019-00","Standard Bronze Off Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","22"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350016","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350016.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350016-01","Standard Gold On Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350017","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350017-00","Standard Silver Off Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350017","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350017-01","Standard Silver On Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","19"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350018","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350018.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350018-00","Standard Bronze Off Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","20"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270027","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","89"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270027","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270027-03","Limited Cost Sharing Plan Variation","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","90"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-00","Standard Silver Off Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","63"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-01","Standard Silver On Exchange Plan","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","64"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","65"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-03","Limited Cost Sharing Plan Variation","71.70%","0.717462003231049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2900","80","870","30","1150","1970","0","0","66"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-04","73% AV Level Silver Plan","73.70%","0.79856675863266","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","70","0","30","1150","1610","0","0","67"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","68"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270020","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270020.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270020-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","69"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-00","Standard Silver Off Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","70"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250036","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250036-00","Standard Bronze Off Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","67"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250036","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250036-01","Standard Bronze On Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","68"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250036","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","69"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250036","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250036-03","Limited Cost Sharing Plan Variation","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","70"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-00","Standard Silver Off Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","41"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-01","Standard Silver On Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","42"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010017","Empower - Catastrophic 6350/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerCatastrophic6350-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerCatastrophic6350-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010017-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$23,200","$46,400","$29,550","$59,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","15"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","1","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0370001","Anthem Dental Pediatric","90028WI037",,"WIN001","WIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212963.pdf",,,,"90028WI0370001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-01","Standard Silver On Exchange Plan","70.30%","0.702557682991028","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","1460","30","1150","1970","0","0","71"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","72"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","75"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270021","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270021.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270021-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","76"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-00","Standard Silver Off Exchange Plan","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","77"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-01","Standard Silver On Exchange Plan","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","78"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","0","0","0","0","0","79"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-03","Limited Cost Sharing Plan Variation","70.00%","0.699841439723969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"3400","80","1150","30","1150","1970","0","0","80"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-04","73% AV Level Silver Plan","72.10%","0.783713340759277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"2400","80","0","30","1150","1970","0","0","81"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-05","87% AV Level Silver Plan","86.20%","0.898580968379974","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"1000","70","0","30","500","1000","0","0","82"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","2","84670","WI","Individual","No","20-2660193","84670WI1270022","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF003","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,"$500","0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250022.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270022-06","94% AV Level Silver Plan","94.20%","0.958017408847809","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"500","50","0","30","250","250","0","0","83"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330015","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330015-00","Standard Bronze Off Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330015","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330015.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330015-01","Standard Bronze On Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330016","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330016.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330016-00","Standard Gold Off Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330016","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330016.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330016-01","Standard Gold On Exchange Plan","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","7"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330017","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330017-00","Standard Silver Off Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","8"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330017","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330017.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330017-01","Standard Silver On Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330018","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330018.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330018-00","Standard Bronze Off Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330018","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330018.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330018-01","Standard Bronze On Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1330019","HealthyEngage","84670WI133",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/133001901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1330019.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1330019-00","Standard Bronze Off Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","3","84670","WI","SHOP (Small Group)","No","20-2660193","84670WI1350019","HealthyEngage","84670WI135",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/135001901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1350019.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1350019-01","Standard Bronze On Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","23"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250024","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250024-00","Standard Bronze Off Exchange Plan","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","4"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250024","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250024-01","Standard Bronze On Exchange Plan","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250024","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250025","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250025-01","Standard Bronze On Exchange Plan","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","9"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250025","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","10"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250025","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250025-03","Limited Cost Sharing Plan Variation","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250026","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250026-00","Standard Bronze Off Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250026","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250026-01","Standard Bronze On Exchange Plan","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","13"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250026","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250026","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250026.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250026-03","Limited Cost Sharing Plan Variation","61.70%","0.616558730602264","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5900","0","270","30","5000","0","70","0","15"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250027","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250027-00","Standard Bronze Off Exchange Plan","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","16"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250027","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250027-01","Standard Bronze On Exchange Plan","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","17"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250027","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250027-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","18"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250028","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250028-03","Limited Cost Sharing Plan Variation","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","23"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-00","Standard Silver Off Exchange Plan","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","24"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-01","Standard Silver On Exchange Plan","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","25"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","26"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-03","Limited Cost Sharing Plan Variation","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","27"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250029","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250029-04","73% AV Level Silver Plan","72.90%","0.729270815849304","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","28"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-04","73% AV Level Silver Plan","73.89%","0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","35"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250030","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250030-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","36"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6300 - 0%","91058WI008",,"WIN001","WIS001","WIF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-00","Standard Silver Off Exchange Plan",,"0.682069897651672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","57"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250033","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250033-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","58"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","111"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-03","Limited Cost Sharing Plan Variation","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","112"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-04","73% AV Level Silver Plan","72.90%","0.729270815849304","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","113"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","114"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","27"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-03","Limited Cost Sharing Plan Variation",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","28"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-04","73% AV Level Silver Plan",,"0.738043427467346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$1,200","$150","$1,300","$0","$790","$80","29"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-05","87% AV Level Silver Plan",,"0.877109706401825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$2,000","$4,000","$2,100","$4,200","$100","$0","$1,440","$150","$100","$0","$1,030","$80","30"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-06","94% AV Level Silver Plan",,"0.930102705955505","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$830","$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$0","$830","$150","$0","$0","$830","$80","31"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower - Bronze 5800/100","87416WI002",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020014-00","Standard Bronze Off Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010018","Empower - Bronze 5800/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$117.09","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010018-00","Standard Bronze Off Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020014","Empower - Bronze 5800/100","87416WI002",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020014-01","Standard Bronze On Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-00","Standard Silver Off Exchange Plan","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","45"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-01","Standard Silver On Exchange Plan","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","46"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","47"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-03","Limited Cost Sharing Plan Variation","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","48"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-00","Standard Silver Off Exchange Plan","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","95"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-01","Standard Silver On Exchange Plan","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","96"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-06","94% AV Level Silver Plan",,"0.930528700351715","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$20","$1,030","$150","$0","$250","$280","$80","47"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020011-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020011","Empower - Silver 2000/80","87416WI002",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020011-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270028","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270028-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","93"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270028","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Gold","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002801",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270028.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270028-03","Limited Cost Sharing Plan Variation","78.80%","0.788134396076202","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","2900","0","0","30","2000","0","0","0","94"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270035","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270035-03","Limited Cost Sharing Plan Variation","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","137"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270036","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270036-00","Standard Bronze Off Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","138"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270034","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270034-03","Limited Cost Sharing Plan Variation","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","133"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270035","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270035-00","Standard Bronze Off Exchange Plan","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","134"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270035","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270035-01","Standard Bronze On Exchange Plan","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","135"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270035","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","136"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080006","Bronze HSA $2500 - 50% Expanded","91058WI008",,"WIN002","WIS001","WIF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080006-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-04","73% AV Level Silver Plan",,"0.723856747150421","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","43"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-03","Limited Cost Sharing Plan Variation",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","44"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-04","73% AV Level Silver Plan",,"0.739448189735413","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","45"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010022","Envision - Silver 2000/80/Copay30","87416WI001",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$82.14","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010022-05","87% AV Level Silver Plan",,"0.874741733074188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$40","$1,030","$150","$0","$500","$280","$860","46"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-04","73% AV Level Silver Plan","73.70%","0.736850261688232","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","49"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250032","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF006","New","HMO","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250032-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","50"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270024","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270024-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","77"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270024","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270024-03","Limited Cost Sharing Plan Variation","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,700","$33,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","78"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270025","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270025-00","Standard Bronze Off Exchange Plan","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,000","$34,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","79"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270025","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270025-01","Standard Bronze On Exchange Plan","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,000","$34,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","80"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270025","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270025-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","81"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270025","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270025.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270025-03","Limited Cost Sharing Plan Variation","61.30%","0.612933993339539","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,000","$34,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable","6400","0","90","30","5350","0","0","0","82"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250037","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250037-00","Standard Bronze Off Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","71"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250037","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250037-01","Standard Bronze On Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","72"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250037","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","73"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250037","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF007","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250037-03","Limited Cost Sharing Plan Variation","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","74"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270024","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270024-00","Standard Bronze Off Exchange Plan","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,700","$33,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","75"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270024","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270024.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270024-01","Standard Bronze On Exchange Plan","60.40%","0.603946685791016","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,700","$33,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","7250","0","0","30","5350","0","0","0","76"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270027","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270027-00","Standard Bronze Off Exchange Plan","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","87"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270027","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270027.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270027-01","Standard Bronze On Exchange Plan","61.90%","0.618951320648193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","5400","0","560","30","4500","0","260","0","88"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010018","Empower - Bronze 5800/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$117.09","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010018-01","Standard Bronze On Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision - Bronze 5800/100","87416WI002",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020021-00","Standard Bronze Off Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250034","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250034-00","Standard Bronze Off Exchange Plan","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","59"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250034","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250034-01","Standard Bronze On Exchange Plan","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","60"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250034","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","61"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250034","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250034-03","Limited Cost Sharing Plan Variation","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","62"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250035","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250035-00","Standard Bronze Off Exchange Plan","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","63"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250035","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250035-01","Standard Bronze On Exchange Plan","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","64"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250035","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250035-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","0","0","0","0","0","0","0","0","65"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1250035","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF005","New","HMO","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003501",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250035.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250035-03","Limited Cost Sharing Plan Variation","61.60%","0.616026341915131","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","5400","0","190","30","4500","0","90","0","66"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270034","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270034-01","Standard Bronze On Exchange Plan","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","131"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270034","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270034-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","132"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-01","Standard Silver On Exchange Plan",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","35"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","36"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision - Gold 500/90","87416WI002",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020016-00","Standard Gold Off Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","12"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-01","Standard Silver On Exchange Plan",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","13"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020016","Envision - Gold 500/90","87416WI002",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020016-01","Standard Gold On Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","13"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision - Silver 2000/80/Copay30","87416WI002",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020017-00","Standard Silver Off Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-04","73% AV Level Silver Plan","72.90%","0.729270815849304","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$6,800","$13,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,800","$5,600","0%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","99"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","100"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-00","Standard Silver Off Exchange Plan","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","109"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-01","Standard Silver On Exchange Plan","68.70%","0.686612367630005","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","340","30","3000","0","240","0","110"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270031","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF005","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003101",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270031.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270031-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","115"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-00","Standard Silver Off Exchange Plan","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","116"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-01","Standard Silver On Exchange Plan","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","117"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","118"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","21"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-03","Limited Cost Sharing Plan Variation",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","22"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-04","73% AV Level Silver Plan",,"0.739448189735413","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","23"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-05","87% AV Level Silver Plan",,"0.874741733074188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$40","$1,030","$150","$0","$500","$280","$860","24"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-06","94% AV Level Silver Plan",,"0.930528700351715","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$20","$1,030","$150","$0","$250","$280","$80","25"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision - Gold 500/80","87416WI001",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$62.53","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010019-00","Standard Gold Off Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","26"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270036","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270036-03","Limited Cost Sharing Plan Variation","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","141"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270037","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270037-00","Standard Bronze Off Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","142"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270037","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270037-01","Standard Bronze On Exchange Plan","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","143"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270037","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270037-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","144"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","101"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-00","Standard Silver Off Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","102"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision - Gold 500/90","87416WI001",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$55.66","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010020-01","Standard Gold On Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","31"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision - Gold 500/90","87416WI001",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$55.66","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","32"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270036","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270036-01","Standard Bronze On Exchange Plan","58.40%","0.584089159965515","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","6400","0","170","30","5350","0","0","0","139"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270036","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003601",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270036.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270036-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","140"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270037","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003701",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270037.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270037-03","Limited Cost Sharing Plan Variation","61.60%","0.615601360797882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,500","$27,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","860","30","3500","0","590","0","145"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","6","84670","WI","Individual","No","20-2660193","84670WI1250039","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Catastrophic","Yes","Both","No","Yes","Non-participating & tertiary providers","Child only does not apply","$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250039.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250039-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,250","$0","$0","$30","$5,350","$0","$0","$0","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision - Gold 500/90","87416WI001",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$55.66","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010020-03","Limited Cost Sharing Plan Variation",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","33"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-00","Standard Silver Off Exchange Plan",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","34"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","97"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270029","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127002901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270029.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270029-03","Limited Cost Sharing Plan Variation","68.80%","0.688423991203308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","4400","0","0","30","3500","0","0","0","98"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010011","Empower - Gold 500/90","87416WI001",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$64.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision - Gold 500/80","87416WI002",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020015-01","Standard Gold On Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","11"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010011","Empower - Gold 500/90","87416WI001",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$64.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010011-03","Limited Cost Sharing Plan Variation",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","11"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-00","Standard Silver Off Exchange Plan",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","12"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","103"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","104"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","3900","0","0","30","3000","0","0","0","105"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-04","73% AV Level Silver Plan","73.89%","0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$6,650","$13,300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"$2,650","$5,300","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","106"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","107"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270030","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003001",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270030.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270030-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","108"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-03","Limited Cost Sharing Plan Variation","68.40%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","3400","0","770","30","2500","0","580","0","119"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-04","73% AV Level Silver Plan","73.70%","0.736850261688232","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","120"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","121"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270032","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF006","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003201",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270032.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270032-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","122"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-00","Standard Silver Off Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","123"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-01","Standard Silver On Exchange Plan","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","124"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","0","0","0","0","0","125"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-03","Limited Cost Sharing Plan Variation","68.20%","0.681804835796356","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","2400","0","1470","30","1500","0","1160","0","126"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-04","73% AV Level Silver Plan","74.00%","0.739748239517212","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","3550","0","0","30","2650","0","0","0","127"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-05","87% AV Level Silver Plan","87.70%","0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","1900","0","0","30","1000","0","0","0","128"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270033","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF007","New","POS","Silver","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003301",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270033.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270033-06","94% AV Level Silver Plan","93.30%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","1000","0","0","30","500","0","0","0","129"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","4","84670","WI","Individual","No","20-2660193","84670WI1270034","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Bronze","Yes","Both","No","Yes","Non-participating & tertiary providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is provided for medically necessary out-of-network services","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003401",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270034.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270034-00","Standard Bronze Off Exchange Plan","59.20%","0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","6900","0","0","30","5350","0","0","0","130"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-03","Limited Cost Sharing Plan Variation",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","37"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-04","73% AV Level Silver Plan",,"0.739448189735413","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","38"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-05","87% AV Level Silver Plan",,"0.874741733074188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$40","$1,030","$150","$0","$500","$280","$860","39"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010021","Envision - Silver 3000/80","87416WI001",,"WIN002","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$89.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010021-06","94% AV Level Silver Plan",,"0.930528700351715","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$20","$1,030","$150","$0","$250","$280","$80","40"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","1","90028","WI","Individual","Yes","39-0138065","90028WI0400001","Anthem Dental Pediatric","90028WI040",,"WIN001","WIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.37",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212963.pdf",,,,"90028WI0400001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","1","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0370002","Anthem Dental Pediatric Enhanced","90028WI037",,"WIN001","WIS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e213351.pdf",,,,"90028WI0370002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","1","90028","WI","Individual","Yes","39-0138065","90028WI0400052","Anthem Dental Pediatric Enhanced","90028WI040",,"WIN001","WIS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e213351.pdf",,,,"90028WI0400052-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080005","Silver HSA $2000 - 20% Expanded","91058WI008",,"WIN002","WIS001","WIF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080005-01","Standard Silver On Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-03","Limited Cost Sharing Plan Variation",,"0.682069897651672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","6","84670","WI","Individual","No","20-2660193","84670WI1250039","Healthy1Engage","84670WI125",,"WIN002","WIS002","WIF004","New","HMO","Catastrophic","Yes","Both","No","Yes","Non-participating & tertiary providers","Child only does not apply","$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/125003901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1250039.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1250039-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,250","$0","$0","$30","$5,350","$0","$0","$0","5"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","6","84670","WI","Individual","No","20-2660193","84670WI1270039","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Catastrophic","Yes","Both","No","Yes","Non-participating & tertiary providers","Child only does not apply","$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270039.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270039-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,700","$33,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$7,250","$0","$0","$30","$5,350","$0","$0","$0","6"
"2014","WI","84670","HIOS","9","2014-05-02 13:10:05","6","84670","WI","Individual","No","20-2660193","84670WI1270039","Healthy1Engage","84670WI127",,"WIN002","WIS002","WIF004","New","POS","Catastrophic","Yes","Both","No","Yes","Non-participating & tertiary providers","Child only does not apply","$0.00","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage is limited to emergency care only","Yes","Coverage is limited to emergency care only","No","https://secure.wecareforwisconsin.com/visitors/find_sbc/127003901",,"http://www.wecareforwisconsin.com/documents/Plans_and_Products/HIOS/84670WI1270039.pdf","http://www.wecareforwisconsin.com/members/formulary/view_drug_formulary/","84670WI1270039-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,700","$33,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$7,250","$0","$0","$30","$5,350","$0","$0","$0","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010010","Empower - Gold 500/80","87416WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$72.27","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010010-00","Standard Gold Off Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower - Gold 500/80","87416WI002",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020008-00","Standard Gold Off Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","4"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010010","Empower - Gold 500/80","87416WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$72.27","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010010-01","Standard Gold On Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","5"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020008","Empower - Gold 500/80","87416WI002",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020008-01","Standard Gold On Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","5"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower - Gold 500/90","87416WI002",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020009-00","Standard Gold Off Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","6"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010010","Empower - Gold 500/80","87416WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$72.27","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020009","Empower - Gold 500/90","87416WI002",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020009-01","Standard Gold On Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010010","Empower - Gold 500/80","87416WI001",,"WIN001","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$72.27","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010010-03","Limited Cost Sharing Plan Variation",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower - Silver 2000/80/Copay30","87416WI002",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020010-00","Standard Silver Off Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","8"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010011","Empower - Gold 500/90","87416WI001",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$64.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010011-00","Standard Gold Off Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","8"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020010","Empower - Silver 2000/80/Copay30","87416WI002",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020010-01","Standard Silver On Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","9"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010011","Empower - Gold 500/90","87416WI001",,"WIN001","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$64.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010011-01","Standard Gold On Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","9"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020015","Envision - Gold 500/80","87416WI002",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020015-00","Standard Gold Off Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","10"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","14"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-03","Limited Cost Sharing Plan Variation",,"0.683428943157196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$3,000","$20","$850","$150","$3,000","$620","$120","$80","15"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020017","Envision - Silver 2000/80/Copay30","87416WI002",,"WIN002","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020017-01","Standard Silver On Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","15"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-04","73% AV Level Silver Plan",,"0.739448189735413","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","16"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-05","87% AV Level Silver Plan",,"0.877109706401825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$2,000","$4,000","$2,100","$4,200","$100","$0","$1,440","$150","$100","$0","$1,030","$80","23"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-06","94% AV Level Silver Plan",,"0.930102705955505","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$830","$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$0","$830","$150","$0","$0","$830","$80","24"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-00","Standard Silver Off Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","25"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010024","Envision - Silver 1500/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$82.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010024-01","Standard Silver On Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","26"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010018","Empower - Bronze 5800/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$117.09","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010018","Empower - Bronze 5800/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$117.09","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010018-03","Limited Cost Sharing Plan Variation",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020021","Envision - Bronze 5800/100","87416WI002",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020021-01","Standard Bronze On Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision - Bronze 5800/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$101.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010027-00","Standard Bronze Off Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","8"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010026","Envision - Catastrophic 6350/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionCatastrophic6350-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionCatastrophic6350-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$23,200","$46,400","$29,550","$59,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","13"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010017","Empower - Catastrophic 6350/100","87416WI001",,"WIN001","WIS001","WIF006","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerCatastrophic6350-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerCatastrophic6350-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010017-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$23,200","$46,400","$29,550","$59,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","14"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","2","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0390001","Anthem Dental Family","90028WI039",,"WIN001","WIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212961.pdf",,,,"90028WI0390001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","2","90028","WI","Individual","Yes","39-0138065","90028WI0420001","Anthem Dental Family","90028WI042",,"WIN001","WIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212961.pdf",,,,"90028WI0420001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","2","90028","WI","Individual","Yes","39-0138065","90028WI0420052","Anthem Dental Family Enhanced","90028WI042",,"WIN001","WIS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212962.pdf",,,,"90028WI0420052-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision - Bronze 5800/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$101.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010027-01","Standard Bronze On Exchange Plan",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","9"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision - Bronze 5800/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$101.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010027","Envision - Bronze 5800/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Bronze","No","Both","Yes","No",,,"$101.30","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionBronze5800-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionBronze5800-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010027-03","Limited Cost Sharing Plan Variation",,"0.619809925556183","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$23,200","$46,400","$29,000","$58,000",,,,,,,,,,,,,,,,,,,,,"$5,800","$11,600","0%",,,,"$11,600","$23,200","$17,400","$34,800","$5,800","$0","$0","$150","$5,270","$0","$0","$80","11"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","3","87416","WI","Individual","No","45-3309488","87416WI0010026","Envision - Catastrophic 6350/100","87416WI001",,"WIN002","WIS001","WIF006","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionCatastrophic6350-100.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionCatastrophic6350-100.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010026-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$23,200","$46,400","$29,550","$59,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","12"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-05","87% AV Level Silver Plan",,"0.874741733074188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$40","$1,030","$150","$0","$500","$280","$860","17"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010012","Empower - Silver 3000/80","87416WI001",,"WIN001","WIS001","WIF001","New","PPO","Silver","No","Both","Yes","No",,,"$103.33","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver3000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver3000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010012-06","94% AV Level Silver Plan",,"0.930528700351715","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$4,500","$9,000","$5,700","$11,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$20","$1,030","$150","$0","$250","$280","$80","18"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-00","Standard Silver Off Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","19"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010013","Empower - Silver 2000/80/Copay30","87416WI001",,"WIN001","WIS001","WIF002","New","PPO","Silver","No","Both","Yes","No",,,"$94.94","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80-Copay30.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80-Copay30.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010013-01","Standard Silver On Exchange Plan",,"0.718460619449615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$50","$1,010","$150","$2,000","$440","$190","$80","20"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision - Gold 500/80","87416WI001",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$62.53","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010019-01","Standard Gold On Exchange Plan",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","27"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision - Gold 500/80","87416WI001",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$62.53","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","28"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-01","Standard Silver On Exchange Plan","70.17%","0.701671302318573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-06","94% AV Level Silver Plan",,"0.930102705955505","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$830","$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$0","$830","$150","$0","$0","$830","$80","17"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","18"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","19"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","20"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070012","Platinum $500 - 20% $15 OV Expanded","91058WI007",,"WIN002","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070012-00","Standard Platinum Off Exchange Plan","88.29%","0.882930278778076","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 � 30%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050003-03","Limited Cost Sharing Plan Variation","80.83%","0.80832302570343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070001-01","Standard Platinum On Exchange Plan","91.17%","0.911718785762787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070002-00","Standard Platinum Off Exchange Plan","88.29%","0.882930278778076","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080007","Bronze HSA $5000 - 30% Expanded","91058WI008",,"WIN002","WIS001","WIF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080007-00","Standard Bronze Off Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080007","Bronze HSA $5000 - 30% Expanded","91058WI008",,"WIN002","WIS001","WIF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080007-01","Standard Bronze On Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-01","Standard Silver On Exchange Plan","69.06%","0.690641224384308","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"29"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010019","Envision - Gold 500/80","87416WI001",,"WIN002","WIS001","WIF004","New","PPO","Gold","No","Both","Yes","No",,,"$62.53","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010019-03","Limited Cost Sharing Plan Variation",,"0.784706950187683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$1,010","$150","$500","$680","$240","$80","29"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","1","87416","WI","Individual","No","45-3309488","87416WI0010020","Envision - Gold 500/90","87416WI001",,"WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","Yes","No",,,"$55.66","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionGold500-90.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionGold500-90.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010020-00","Standard Gold Off Exchange Plan",,"0.815297067165375","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$50","$510","$150","$500","$680","$120","$80","30"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","5"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower - Silver 1500/80","87416WI002",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020012-00","Standard Silver Off Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","6"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-03","Limited Cost Sharing Plan Variation",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020012","Empower - Silver 1500/80","87416WI002",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020012-01","Standard Silver On Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","7"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-04","73% AV Level Silver Plan",,"0.738043427467346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$1,200","$150","$1,300","$0","$790","$80","8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080004","Bronze HSA $6300 - 0%","91058WI008",,"WIN001","WIS001","WIF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-01","Standard Silver On Exchange Plan",,"0.682069897651672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080005","Silver HSA $2000 - 20% Expanded","91058WI008",,"WIN002","WIS001","WIF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080005-00","Standard Silver Off Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020018-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","8"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020018","Envision - Silver 2000/80","87416WI002",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020018-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","9"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-05","87% AV Level Silver Plan",,"0.877109706401825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$2,000","$4,000","$2,100","$4,200","$100","$0","$1,440","$150","$100","$0","$1,030","$80","9"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision - Silver 1500/80","87416WI002",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020019-00","Standard Silver Off Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","10"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010014","Empower - Silver 2000/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$102.69","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010014-06","94% AV Level Silver Plan",,"0.930102705955505","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$830","$1,660",,,"$4,500","$9,000","$5,330","$10,660",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$0","$830","$150","$0","$0","$830","$80","10"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-00","Standard Silver Off Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","11"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","SHOP (Small Group)","No","45-3309488","87416WI0020019","Envision - Silver 1500/80","87416WI002",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/SG-SBC-EnvisionSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/SG-BR-EnvisionSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0020019-01","Standard Silver On Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","11"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-01","Standard Silver On Exchange Plan",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","12"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","13"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-03","Limited Cost Sharing Plan Variation",,"0.715797424316406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","14"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-04","73% AV Level Silver Plan",,"0.738043427467346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$1,200","$150","$1,300","$0","$790","$80","15"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010015","Empower - Silver 1500/80","87416WI001",,"WIN001","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$95.55","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EmpowerSilver1500-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EmpowerSilver1500-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010015-05","87% AV Level Silver Plan",,"0.877109706401825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","$6,750","$13,500",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$2,000","$4,000","$2,100","$4,200","$100","$0","$1,440","$150","$100","$0","$1,030","$80","16"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 � 0%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050004-01","Standard Gold On Exchange Plan","78.59%","0.785882353782654","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 � 0%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070016","Silver $2000 - 20% $40 OV Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070016-00","Standard Silver Off Exchange Plan","71.15%","0.711495935916901","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070016","Silver $2000 - 20% $40 OV Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070016-01","Standard Silver On Exchange Plan","71.15%","0.711495935916901","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 � 0%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050004-03","Limited Cost Sharing Plan Variation","78.59%","0.785882353782654","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-00","Standard Silver Off Exchange Plan","70.17%","0.701671302318573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070012","Platinum $500 - 20% $15 OV Expanded","91058WI007",,"WIN002","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070012-01","Standard Platinum On Exchange Plan","88.29%","0.882930278778076","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070014","Gold $1000 - 20% $40 OV Expanded","91058WI007",,"WIN002","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070014-00","Standard Gold Off Exchange Plan","79.94%","0.799402117729187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050004","Gold $3500 � 0%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050004-00","Standard Gold Off Exchange Plan","78.59%","0.785882353782654","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070014","Gold $1000 - 20% $40 OV Expanded","91058WI007",,"WIN002","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070014-01","Standard Gold On Exchange Plan","79.94%","0.799402117729187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-03","Limited Cost Sharing Plan Variation",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,060","$150","$2,000","$0","$650","$80","21"
"2014","WI","87416","HIOS","6","2013-10-15 07:27:56","2","87416","WI","Individual","No","45-3309488","87416WI0010023","Envision - Silver 2000/80","87416WI001",,"WIN002","WIS001","WIF005","New","PPO","Silver","No","Both","Yes","No",,,"$88.84","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","May be subject to Out of Network Benefit","Yes","http://commongroundhealthcare.org/assets/pdf/INDV-SBC-EnvisionSilver2000-80.pdf","https://healthplans.commongroundhealthcare.org/ehp/eapp/samlpaymentacs","http://commongroundhealthcare.org/assets/pdf/INDV-BR-EnvisionSilver2000-80.pdf","http://commongroundhealthcare.org/assets/pdf/formulary.pdf","87416WI0010023-04","73% AV Level Silver Plan",,"0.738043427467346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","$15,600","$31,200",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$2,600","$5,200","$3,900","$7,800","$1,300","$0","$1,200","$150","$1,300","$0","$790","$80","22"
"2014","WI","90028","HIOS","5","2014-03-19 07:06:49","2","90028","WI","SHOP (Small Group)","Yes","39-0138065","90028WI0390002","Anthem Dental Family Enhanced","90028WI039",,"WIN001","WIS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/wi/f0/s0/t0/pw_e212962.pdf",,,,"90028WI0390002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070001","Platinum $1000 - 0% $30 OV","91058WI007",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070001-00","Standard Platinum Off Exchange Plan","91.17%","0.911718785762787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 � 0%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050001-00","Standard Platinum Off Exchange Plan","90.73%","0.907304048538208","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 � 0%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050001-01","Standard Platinum On Exchange Plan","90.73%","0.907304048538208","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $4500 � 20%","91058WI006",,"WIN003","WIS001","WIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 � 0%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070002","Platinum $500 - 20% $15 OV","91058WI007",,"WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070002-01","Standard Platinum On Exchange Plan","88.29%","0.882930278778076","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050001","Platinum $1000 � 0%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050001-03","Limited Cost Sharing Plan Variation","90.73%","0.907304048538208","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5000 - 30%","91058WI008",,"WIN001","WIS001","WIF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080003-01","Standard Bronze On Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-06","94% AV Level Silver Plan",,"0.941158354282379","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $2500 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060003-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080008","Bronze HSA $6300 - 0% Expanded","91058WI008",,"WIN002","WIS001","WIF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080008-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $2500 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060003-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080008","Bronze HSA $6300 - 0% Expanded","91058WI008",,"WIN002","WIS001","WIF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080008-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $2500 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060003","Bronze HSA $2500 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060003-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $5500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060004-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $5500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060004-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $5500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060004","Bronze HSA $5500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060004-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $5500 � 20%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050010-03","Limited Cost Sharing Plan Variation","60.07%","0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070017","Silver - 50% Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070017-01","Standard Silver On Exchange Plan","71.38%","0.713833391666412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","6","91058","WI","Individual","No","39-1807071","91058WI0050014","Catastrophic $6,350 - 0%","91058WI005",,"WIN003","WIS001","WIF008","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","6","91058","WI","Individual","No","39-1807071","91058WI0050014","Catastrophic $6,350 - 0%","91058WI005",,"WIN003","WIS001","WIF008","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","91604","HIOS","6","2014-01-16 07:24:04","1","91604","WI","Individual","Yes","39-1263473","91604WI0490001","Humana Dental Smart Choice","91604WI049",,"WIN001","WIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"91604WI0490001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220004","GHC Gold Plated HMO, $1,250 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220004-00","Standard Gold Off Exchange Plan",,"0.791709005832672","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210003","GHC Gold Plated HMO, $1,500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$3,000","$0","$0","$190","$3,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI022","7558364783","WIN001","WIS001","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220007-00","Standard Silver Off Exchange Plan",,"0.717205286026001","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$500","$0","$150","$4,000","$40","$60","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-01","Standard Silver On Exchange Plan",,"0.717205286026001","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$500","$0","$150","$4,000","$40","$60","$80","5"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","4","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0060001","Guardian Family Essentials","38921WY006",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0060001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","4","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0060001","Guardian Family Essentials","38921WY006",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0060001-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","1","47731","WY","Individual","Yes","95-6042390","47731WY0030001","BESTOne Child Dental Plus","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Child_Dental_Plus_Plan.pdf",,"47731WY0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020001","BEST Life Child Dental Plus","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Child_Dental_Plus_Plan.pdf",,"47731WY0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","1","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020001","BEST Life Child Dental Plus","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Child_Dental_Plus_Plan.pdf",,"47731WY0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","1","47731","WY","Individual","Yes","95-6042390","47731WY0030001","BESTOne Child Dental Plus","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Child_Dental_Plus_Plan.pdf",,"47731WY0030001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080006","Bronze HSA $2500 - 50% Expanded","91058WI008",,"WIN002","WIS001","WIF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080006-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060002","Silver HSA $2000 � 50%","91058WI006",,"WIN003","WIS001","WIF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060002-05","87% AV Level Silver Plan",,"0.864543795585632","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $4500 � 20%","91058WI006",,"WIN003","WIS001","WIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060005-03","Limited Cost Sharing Plan Variation",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-00","Standard Silver Off Exchange Plan","68.90%","0.689048707485199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070003-00","Standard Gold Off Exchange Plan","81.84%","0.818400382995605","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-01","Standard Silver On Exchange Plan","68.90%","0.689048707485199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070003","Gold $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070003-01","Standard Gold On Exchange Plan","81.84%","0.818400382995605","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $2000 - 20%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070005-00","Standard Silver Off Exchange Plan","71.96%","0.719587922096252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070005","Silver $2000 - 20%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070005-01","Standard Silver On Exchange Plan","71.96%","0.719587922096252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $4500 � 20%","91058WI006",,"WIN003","WIS001","WIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060005-00","Standard Bronze Off Exchange Plan",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060005","Bronze HSA $4500 � 20%","91058WI006",,"WIN003","WIS001","WIF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060005-01","Standard Bronze On Exchange Plan",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 � 20%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050002-00","Standard Platinum Off Exchange Plan","90.37%","0.903732120990753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $1000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070004-00","Standard Gold Off Exchange Plan","79.94%","0.799402117729187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 � 20%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050002-01","Standard Platinum On Exchange Plan","90.37%","0.903732120990753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070004","Gold $1000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070004-01","Standard Gold On Exchange Plan","79.94%","0.799402117729187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $2000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070006-00","Standard Silver Off Exchange Plan","71.15%","0.711495935916901","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 � 20%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050002","Platinum $500 � 20%","91058WI005",,"WIN003","WIS001","WIF009","New","POS","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050002-03","Limited Cost Sharing Plan Variation","90.37%","0.903732120990753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070006","Silver $2000 - 20% $40 OV","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070006-01","Standard Silver On Exchange Plan","71.15%","0.711495935916901","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 � 30%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050003-00","Standard Gold Off Exchange Plan","80.83%","0.80832302570343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070011","Platinum $1000 - 0% $30 OV Expanded","91058WI007",,"WIN002","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070011-00","Standard Platinum Off Exchange Plan","91.17%","0.911718785762787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 � 30%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050003-01","Standard Gold On Exchange Plan","80.83%","0.80832302570343","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","45%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070011","Platinum $1000 - 0% $30 OV Expanded","91058WI007",,"WIN002","WIS001","WIF001","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070011-01","Standard Platinum On Exchange Plan","91.17%","0.911718785762787","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050003","Gold $1500 � 30%","91058WI005",,"WIN003","WIS001","WIF010","New","POS","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-03","Limited Cost Sharing Plan Variation","70.17%","0.701671302318573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-04","73% AV Level Silver Plan","72.81%","0.728078246116638","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-05","87% AV Level Silver Plan","87.05%","0.87049925327301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050005","Silver $3500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050005-06","94% AV Level Silver Plan","93.58%","0.935769379138947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-00","Standard Silver Off Exchange Plan","69.06%","0.690641224384308","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-03","Limited Cost Sharing Plan Variation","69.06%","0.690641224384308","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-04","73% AV Level Silver Plan","73.09%","0.730945885181427","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-05","87% AV Level Silver Plan","87.28%","0.872846245765686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","1","91058","WI","Individual","No","39-1807071","91058WI0050006","Silver $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050006-06","94% AV Level Silver Plan","93.58%","0.935769379138947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $2000 - 20%","91058WI008",,"WIN001","WIS001","WIF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080001-00","Standard Silver Off Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080001","Silver HSA $2000 - 20%","91058WI008",,"WIN001","WIS001","WIF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080001-01","Standard Silver On Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $2500 - 50%","91058WI008",,"WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080002-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080002","Bronze HSA $2500 - 50%","91058WI008",,"WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080002-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070017","Silver - 50% Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070017-00","Standard Silver Off Exchange Plan","71.38%","0.713833391666412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $5500 � 20%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $3500 � 30%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050009-03","Limited Cost Sharing Plan Variation","61.11%","0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070020","Bronze $6350 - 0%  Expanded","91058WI007",,"WIN002","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070020-01","Standard Bronze On Exchange Plan","60.61%","0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver - 50%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070007-00","Standard Silver Off Exchange Plan","71.38%","0.713833391666412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $5500 � 20%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050010-00","Standard Bronze Off Exchange Plan","60.07%","0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","Individual","No","39-1807071","91058WI0050010","Bronze $5500 � 20%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050010-01","Standard Bronze On Exchange Plan","60.07%","0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","5","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070007","Silver - 50%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070007-01","Standard Silver On Exchange Plan","71.38%","0.713833391666412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080006","WINhealth Gold HSA SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080006-00","Standard Gold Off Exchange Plan","78.20%","0.767684698104858","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","Individual","No","83-0309681","53189WY0070006","WINhealth Gold","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070006-01","Standard Gold On Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080007","WINhealth Bronze D-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent care withouth preauth, non-emergent care requires preauth","Yes","Only in cases of sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080007-00","Standard Bronze Off Exchange Plan","60.20%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","Individual","No","83-0309681","53189WY0070007","WINhealth Platinum","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070007-00","Standard Platinum Off Exchange Plan","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210004","GHC Gold Plated HMO, $1,250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210004-01","Standard Gold On Exchange Plan",,"0.791709005832672","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-03","Limited Cost Sharing Plan Variation","68.30%","0.68016254901886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-03","Limited Cost Sharing Plan Variation","70.10%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-04","73% AV Level Silver Plan","73.10%","0.666697263717651","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028246.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570001-03","Limited Cost Sharing Plan Variation",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-01","Standard Silver On Exchange Plan",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","Individual","No","83-0309681","53189WY0070007","WINhealth Platinum","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070007-01","Standard Platinum On Exchange Plan","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080007","WINhealth Bronze D-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent care withouth preauth, non-emergent care requires preauth","Yes","Only in cases of sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080007-01","Standard Bronze On Exchange Plan","60.20%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","Individual","No","83-0309681","53189WY0070007","WINhealth Platinum","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080005","WINhealth Silver SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080005-00","Standard Silver Off Exchange Plan","70.50%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-00","Standard Silver Off Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080005","WINhealth Silver SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080005-01","Standard Silver On Exchange Plan","70.50%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-01","Standard Silver On Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-03","Limited Cost Sharing Plan Variation","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-04","73% AV Level Silver Plan","73.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-05","87% AV Level Silver Plan","86.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","5","53189","WY","Individual","No","83-0309681","53189WY0070003","WINhealth Silver HSA","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070003-06","94% AV Level Silver Plan","93.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","Individual","No","83-0309681","53189WY0070006","WINhealth Gold","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070006-00","Standard Gold Off Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0080003","Bronze HSA $5000 - 30%","91058WI008",,"WIN001","WIS001","WIF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0080003-00","Standard Bronze Off Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","2","91058","WI","Individual","No","39-1807071","91058WI0060001","Silver HSA $3500 � 0%","91058WI006",,"WIN003","WIS001","WIF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0060001-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-03","Limited Cost Sharing Plan Variation","68.90%","0.689048707485199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-04","73% AV Level Silver Plan","73.30%","0.733032584190369","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070008-00","Standard Silver Off Exchange Plan","68.59%","0.685942351818085","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-05","87% AV Level Silver Plan","86.46%","0.864616453647614","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220010","GHC Silver Standard HMO, $40 Office Copay","94529WI022","7558364783","WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220010-00","Standard Silver Off Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","12"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220006","GHC Gold Plated HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220006-01","Standard Gold On Exchange Plan",,"0.789184033870697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210004","GHC Gold Plated HMO, $1,250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210004-03","Limited Cost Sharing Plan Variation",,"0.791709005832672","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210005","GHC Gold Plated HMO, $1,750 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210005-00","Standard Gold Off Exchange Plan",,"0.78927344083786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","12"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210005","GHC Gold Plated HMO, $1,750 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210005-01","Standard Gold On Exchange Plan",,"0.78927344083786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","13"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220009","GHC Silver Standard HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220009-01","Standard Silver On Exchange Plan",,"0.707781434059143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$470","$150","$4,000","$40","$60","$80","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080004","WINhealth Platinum-SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080004-00","Standard Platinum Off Exchange Plan","88.00%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-00","Standard Silver Off Exchange Plan","70.10%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080004","WINhealth Platinum-SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080004-01","Standard Platinum On Exchange Plan","88.00%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-01","Standard Silver On Exchange Plan","70.10%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-06","94% AV Level Silver Plan",,"0.940220236778259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-00","Standard Silver Off Exchange Plan",,"0.707781434059143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$470","$150","$4,000","$80","$100","$80","4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070008","Silver $2000 - 0%","91058WI007",,"WIN001","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070008-01","Standard Silver On Exchange Plan","68.59%","0.685942351818085","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","Individual","No","39-1807071","91058WI0050007","Silver $2500 � 20%","91058WI005",,"WIN003","WIS001","WIF011","New","POS","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050007-06","94% AV Level Silver Plan","93.82%","0.938193678855896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070013","Gold $2000 - 0%  Expanded","91058WI007",,"WIN002","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070013-00","Standard Gold Off Exchange Plan","81.84%","0.818400382995605","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070013","Gold $2000 - 0%  Expanded","91058WI007",,"WIN002","WIS001","WIF002","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070013-01","Standard Gold On Exchange Plan","81.84%","0.818400382995605","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070015","Silver $2000 - 20% Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070015-00","Standard Silver Off Exchange Plan","71.96%","0.719587922096252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070015","Silver $2000 - 20% Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070015-01","Standard Silver On Exchange Plan","71.96%","0.719587922096252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070018","Silver $2000 Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070018-00","Standard Silver Off Exchange Plan","68.59%","0.685942351818085","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","3","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070018","Silver $2000 Expanded","91058WI007",,"WIN002","WIS001","WIF003","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070018-01","Standard Silver On Exchange Plan","68.59%","0.685942351818085","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $3500 - 30%","91058WI007",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070009-00","Standard Bronze Off Exchange Plan","60.85%","0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050008-00","Standard Bronze Off Exchange Plan","61.53%","0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050008-01","Standard Bronze On Exchange Plan","61.53%","0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070009","Bronze $3500 - 30%","91058WI007",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070009-01","Standard Bronze On Exchange Plan","60.85%","0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $6350 - 0%","91058WI007",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070010-00","Standard Bronze Off Exchange Plan","60.61%","0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050008","Bronze $2500 � 50%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050008-03","Limited Cost Sharing Plan Variation","61.53%","0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070010","Bronze $6350 - 0%","91058WI007",,"WIN001","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070010-01","Standard Bronze On Exchange Plan","60.61%","0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $3500 � 30%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050009-00","Standard Bronze Off Exchange Plan","61.11%","0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070019","Bronze $3500 - 30% Expanded","91058WI007",,"WIN002","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070019-00","Standard Bronze Off Exchange Plan","60.85%","0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070019","Bronze $3500 - 30% Expanded","91058WI007",,"WIN002","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070019-01","Standard Bronze On Exchange Plan","60.85%","0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $3500 � 30%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050009-01","Standard Bronze On Exchange Plan","61.11%","0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","Individual","No","39-1807071","91058WI0050009","Bronze $3500 � 30%","91058WI005",,"WIN003","WIS001","WIF012","New","POS","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0050009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","91058","HIOS","3","2013-09-02 11:39:25","4","91058","WI","SHOP (Small Group)","No","39-1807071","91058WI0070020","Bronze $6350 - 0%  Expanded","91058WI007",,"WIN002","WIS001","WIF004","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=WI",,,"http://www.gundersenhealthplan.org/QHPformulary","91058WI0070020-00","Standard Bronze Off Exchange Plan","60.61%","0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-06","94% AV Level Silver Plan",,"0.936506807804108","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210012-00","Standard Bronze Off Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$610","$60","$80","27"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210014","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210014-03","Limited Cost Sharing Plan Variation","90.30%","0.877367258071899","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$360","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","Individual","No","39-1199466","94529WI0210011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","Individual","No","39-1199466","94529WI0210011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210011-03","Limited Cost Sharing Plan Variation",,"0.611993968486786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$370","$60","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210002","GHC Platinum Preferred HMO, $250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210002-00","Standard Platinum Off Exchange Plan",,"0.891605138778687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$930","$150","$500","$170","$220","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220005","GHC Gold Plated HMO, $1,750 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220005-01","Standard Gold On Exchange Plan",,"0.78927344083786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","9"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","3","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0050001","Guardian Family Essentials Plus","38921WY005",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage Available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0050001-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","4","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0040001","Guardian Family Advantage","38921WY004",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0040001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","4","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0040001","Guardian Family Advantage","38921WY004",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0040001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210002","GHC Platinum Preferred HMO, $250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$0","$150","$500","$0","$0","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220012-00","Standard Bronze Off Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","14"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","Individual","No","83-0309681","53189WY0070012","WINhealth Gold HSA-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","Individual","No","83-0309681","53189WY0070012","WINhealth Gold HSA-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070012-03","Limited Cost Sharing Plan Variation","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","13","53189","WY","Individual","No","83-0309681","53189WY0070013","WINhealth Gold-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070013-00","Standard Gold Off Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","13","53189","WY","Individual","No","83-0309681","53189WY0070013","WINhealth Gold-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070013-01","Standard Gold On Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","13","53189","WY","Individual","No","83-0309681","53189WY0070013","WINhealth Gold-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","13","53189","WY","Individual","No","83-0309681","53189WY0070013","WINhealth Gold-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070013-03","Limited Cost Sharing Plan Variation","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","Individual","No","39-1199466","94529WI0210008","GHC Bronze HSA-Eligible HMO Plan","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210008-00","Standard Bronze Off Exchange Plan",,"0.592859089374542","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$590","$150","$4,000","$320","$110","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110005","GHC Platinum Preferred PPO Benefit Arch","94529WI011","7558364783","WIN002","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop24&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110005-00","Standard Platinum Off Exchange Plan","90.30%","0.880203008651733","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","80%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$280","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210012-01","Standard Bronze On Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$610","$60","$80","28"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","29"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110003","GHC Silver Standard PPO","94529WI011","7558364783","WIN002","WIS001","WIF003","New","PPO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop18&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110003-00","Standard Silver Off Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210015","GHC Gold Plated HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210015-00","Standard Gold Off Exchange Plan","80.80%","0.783611416816711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","Individual","No","39-1199466","94529WI0210011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210011-00","Standard Bronze Off Exchange Plan",,"0.611993968486786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$370","$60","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","Individual","No","39-1199466","94529WI0210011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210011-01","Standard Bronze On Exchange Plan",,"0.611993968486786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$370","$60","$80","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080006","WINhealth Gold HSA SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080006-01","Standard Gold On Exchange Plan","78.20%","0.767684698104858","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","Individual","No","83-0309681","53189WY0070006","WINhealth Gold","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","6","53189","WY","Individual","No","83-0309681","53189WY0070006","WINhealth Gold","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070006-03","Limited Cost Sharing Plan Variation","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,000","$535","$420","$0","$1,000","$360","$260","$0","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210001","GHC Platinum Preferred HMO, $500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210001-00","Standard Platinum Off Exchange Plan",,"0.893829226493835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$100","$190","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220001","GHC Platinum Preferred HMO, $500 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220001-00","Standard Platinum Off Exchange Plan",,"0.893829226493835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220001","GHC Platinum Preferred HMO, $500 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220001-01","Standard Platinum On Exchange Plan",,"0.893829226493835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210001","GHC Platinum Preferred HMO, $500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210001-01","Standard Platinum On Exchange Plan",,"0.893829226493835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$100","$190","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220002","GHC Platinum Preferred HMO, $250 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220002-00","Standard Platinum Off Exchange Plan",,"0.891605138778687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$930","$150","$500","$200","$240","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210001","GHC Platinum Preferred HMO, $500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220002","GHC Platinum Preferred HMO, $250 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220002-01","Standard Platinum On Exchange Plan",,"0.891605138778687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$930","$150","$500","$200","$240","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210001","GHC Platinum Preferred HMO, $500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind1&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210001-03","Limited Cost Sharing Plan Variation",,"0.893829226493835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$100","$190","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210002","GHC Platinum Preferred HMO, $250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210002-01","Standard Platinum On Exchange Plan",,"0.891605138778687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$930","$150","$500","$170","$220","$80","9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","1","94529","WI","Individual","No","39-1199466","94529WI0210002","GHC Platinum Preferred HMO, $250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind2&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210002-03","Limited Cost Sharing Plan Variation",,"0.891605138778687","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$0","$930","$150","$500","$170","$220","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220003","GHC Gold Plated HMO, $1,500 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220003-00","Standard Gold Off Exchange Plan",,"0.805673062801361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210003","GHC Gold Plated HMO, $1,500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210003-00","Standard Gold Off Exchange Plan",,"0.805673062801361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020002","BEST Life Child Dental","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Child_Dental_Plan.pdf",,"47731WY0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","2","47731","WY","Individual","Yes","95-6042390","47731WY0030002","BESTOne Child Dental","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Child_Dental_Plan.pdf",,"47731WY0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","2","47731","WY","Individual","Yes","95-6042390","47731WY0030002","BESTOne Child Dental","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Child_Dental_Plan.pdf",,"47731WY0030002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","2","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020002","BEST Life Child Dental","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Child_Dental_Plan.pdf",,"47731WY0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","Individual","Yes","95-6042390","47731WY0030003","BESTOne Dental Advantage - Gold","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47731WY0030003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020003","BEST Dental Advantage - Gold","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47731WY0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","Individual","Yes","95-6042390","47731WY0030003","BESTOne Dental Advantage - Gold","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47731WY0030003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020003","BEST Dental Advantage - Gold","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47731WY0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020004","BEST Dental Plus - Gold","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Plus_Plan_(Gold).pdf",,"47731WY0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210003","GHC Gold Plated HMO, $1,500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210003-01","Standard Gold On Exchange Plan",,"0.805673062801361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220003","GHC Gold Plated HMO, $1,500 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220003-01","Standard Gold On Exchange Plan",,"0.805673062801361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-03","Limited Cost Sharing Plan Variation",,"0.717205286026001","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$500","$0","$150","$4,000","$40","$60","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-04","73% AV Level Silver Plan",,"0.73931872844696","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,080","$10,160",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-05","87% AV Level Silver Plan",,"0.866370916366577","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-04","73% AV Level Silver Plan","72.80%","0.714004635810852","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,080","$10,160",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090003","GHC Silver Standard POS","94529WI009","7558364783","WIN002","WIS001","WIF003","New","POS","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop22&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090003-00","Standard Silver Off Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","Individual","No","39-1199466","94529WI0210008","GHC Bronze HSA-Eligible HMO Plan","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210008-01","Standard Bronze On Exchange Plan",,"0.592859089374542","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$590","$150","$4,000","$320","$110","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110005","GHC Platinum Preferred PPO Benefit Arch","94529WI011","7558364783","WIN002","WIS001","WIF001","New","PPO","Platinum","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop24&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110005-01","Standard Platinum On Exchange Plan","90.30%","0.880203008651733","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","80%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$280","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210003","GHC Gold Plated HMO, $1,500 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind3&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210003-03","Limited Cost Sharing Plan Variation",,"0.805673062801361","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220004","GHC Gold Plated HMO, $1,250 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220004-01","Standard Gold On Exchange Plan",,"0.791709005832672","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210004","GHC Gold Plated HMO, $1,250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210004-00","Standard Gold Off Exchange Plan",,"0.791709005832672","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220005","GHC Gold Plated HMO, $1,750 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220005-00","Standard Gold Off Exchange Plan",,"0.78927344083786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220006","GHC Gold Plated HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220006-00","Standard Gold Off Exchange Plan",,"0.789184033870697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210004","GHC Gold Plated HMO, $1,250 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind4&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,500","$0","$0","$150","$2,500","$0","$0","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220010","GHC Silver Standard HMO, $40 Office Copay","94529WI022","7558364783","WIN001","WIS001","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220010-01","Standard Silver On Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","13"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210005","GHC Gold Plated HMO, $1,750 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","14"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220012-01","Standard Bronze On Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","15"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210005","GHC Gold Plated HMO, $1,750 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind5&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210005-03","Limited Cost Sharing Plan Variation",,"0.78927344083786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$0","$0","$150","$3,500","$0","$0","$80","15"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210006","GHC Gold Plated HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210006-00","Standard Gold Off Exchange Plan",,"0.789184033870697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","16"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210006","GHC Gold Plated HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210006-01","Standard Gold On Exchange Plan",,"0.789184033870697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","17"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210006","GHC Gold Plated HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","18"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210006","GHC Gold Plated HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF004","New","HMO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind6&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210006-03","Limited Cost Sharing Plan Variation",,"0.789184033870697","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","19"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-00","Standard Silver Off Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","20"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-01","Standard Silver On Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","21"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$60","$80","22"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-03","Limited Cost Sharing Plan Variation",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","23"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-04","73% AV Level Silver Plan",,"0.735742032527924","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,080","$10,160",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210010","GHC Silver Standard HMO, $40 Office Copay","94529WI021","7558364783","WIN001","WIS002","WIF003","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind10&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210010-05","87% AV Level Silver Plan",,"0.873963415622711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","2","94529","WI","Individual","No","39-1199466","94529WI0210012","GHC Bronze Basic HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF007","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind12&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210012-03","Limited Cost Sharing Plan Variation",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$610","$60","$80","30"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","Individual","No","39-1199466","94529WI0210007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI021","7558364783","WIN001","WIS002","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210007-00","Standard Silver Off Exchange Plan",,"0.717205286026001","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$500","$0","$150","$4,000","$40","$60","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","3","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220007","GHC Silver Standard HMO, 70% Medical Coinsurance","94529WI022","7558364783","WIN001","WIS001","WIF005","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop7&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220007-01","Standard Silver On Exchange Plan",,"0.717205286026001","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$500","$0","$150","$4,000","$40","$60","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220009","GHC Silver Standard HMO, $2,000 Deductible","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220009-00","Standard Silver Off Exchange Plan",,"0.707781434059143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$470","$150","$4,000","$40","$60","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-01","Standard Silver On Exchange Plan",,"0.707781434059143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$470","$150","$4,000","$80","$100","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-03","Limited Cost Sharing Plan Variation",,"0.707781434059143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$0","$470","$150","$4,000","$80","$100","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-04","73% AV Level Silver Plan",,"0.735518217086792","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,080","$10,160",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-05","87% AV Level Silver Plan",,"0.873569488525391","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","4","94529","WI","Individual","No","39-1199466","94529WI0210009","GHC Silver Standard HMO, $2,000 Deductible","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind9&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210009-06","94% AV Level Silver Plan",,"0.940220236778259","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210014","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210014-00","Standard Platinum Off Exchange Plan","90.30%","0.877367258071899","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$360","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110001","GHC Platinum Preferred PPO","94529WI011","7558364783","WIN002","WIS001","WIF001","New","PPO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop16&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110001-00","Standard Platinum Off Exchange Plan",,"0.892860054969788","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210014","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210014-01","Standard Platinum On Exchange Plan","90.30%","0.877367258071899","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$360","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110001","GHC Platinum Preferred PPO","94529WI011","7558364783","WIN002","WIS001","WIF001","New","PPO","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop16&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110001-01","Standard Platinum On Exchange Plan",,"0.892860054969788","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210014","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$0","$0","$150","$1,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110002","GHC Gold Plated PPO","94529WI011","7558364783","WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop17&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110002-00","Standard Gold Off Exchange Plan",,"0.800457358360291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110002","GHC Gold Plated PPO","94529WI011","7558364783","WIN002","WIS001","WIF003","New","PPO","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop17&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110002-01","Standard Gold On Exchange Plan",,"0.800457358360291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110003","GHC Silver Standard PPO","94529WI011","7558364783","WIN002","WIS001","WIF003","New","PPO","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop18&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110003-01","Standard Silver On Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210015","GHC Gold Plated HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210015-01","Standard Gold On Exchange Plan","80.80%","0.783611416816711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110004","GHC Bronze Basic PPO","94529WI011","7558364783","WIN002","WIS001","WIF007","New","PPO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop19&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110004-00","Standard Bronze Off Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210015","GHC Gold Plated HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110004","GHC Bronze Basic PPO","94529WI011","7558364783","WIN002","WIS001","WIF007","New","PPO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop19&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110004-01","Standard Bronze On Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","5","94529","WI","Individual","No","39-1199466","94529WI0210015","GHC Gold Plated HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210015-03","Limited Cost Sharing Plan Variation","80.80%","0.783611416816711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090001","GHC Platinum Preferred POS","94529WI009","7558364783","WIN002","WIS001","WIF001","New","POS","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop20&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090001-00","Standard Platinum Off Exchange Plan",,"0.892860054969788","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-00","Standard Silver Off Exchange Plan","68.30%","0.68016254901886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090001","GHC Platinum Preferred POS","94529WI009","7558364783","WIN002","WIS001","WIF001","New","POS","Platinum","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop20&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090001-01","Standard Platinum On Exchange Plan",,"0.892860054969788","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$140","$220","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-01","Standard Silver On Exchange Plan","68.30%","0.68016254901886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$4,000","$0","$0","$150","$4,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090002","GHC Gold Plated POS","94529WI009","7558364783","WIN002","WIS001","WIF003","New","POS","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop21&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090002-00","Standard Gold Off Exchange Plan",,"0.800457358360291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090002","GHC Gold Plated POS","94529WI009","7558364783","WIN002","WIS001","WIF003","New","POS","Gold","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop21&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090002-01","Standard Gold On Exchange Plan",,"0.800457358360291","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$500","$150","$2,500","$380","$120","$80","7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220008","GHC Bronze HSA-Eligible HMO Plan","94529WI022","7558364783","WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220008-00","Standard Bronze Off Exchange Plan",,"0.592859089374542","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$590","$150","$4,000","$320","$110","$80","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-05","87% AV Level Silver Plan","86.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-06","94% AV Level Silver Plan","94.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","Individual","No","83-0309681","53189WY0070012","WINhealth Gold HSA-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070012-00","Standard Gold Off Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080012","WINhealth Platinum-D","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080012-00","Standard Platinum Off Exchange Plan","88.00%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","Individual","No","83-0309681","53189WY0070012","WINhealth Gold HSA-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070012-01","Standard Gold On Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","12","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080012","WINhealth Platinum-D","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080012-01","Standard Platinum On Exchange Plan","88.00%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","14","53189","WY","Individual","No","83-0309681","53189WY0070014","WINhealth Platinum-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070014-00","Standard Platinum Off Exchange Plan","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","1","83964","WY","Individual","Yes","83-0209667","83964WY0010001","Delta Dental Individual Basic Pediatric Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$43.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109998.aspx","https://secure.deltadentalwy.org/ffm/default.aspx","http://www.deltadentalwy.org/individualoptions/",,"83964WY0010001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","12","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220008","GHC Bronze HSA-Eligible HMO Plan","94529WI022","7558364783","WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220008-01","Standard Bronze On Exchange Plan",,"0.592859089374542","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$590","$150","$4,000","$320","$110","$80","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080003","WINhealth Gold SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080003-00","Standard Gold Off Exchange Plan","78.50%","0.64013808965683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","Individual","No","83-0309681","53189WY0070009","WINhealth Bronze-D","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Only for sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070009-01","Standard Bronze On Exchange Plan","61.30%","0.614531815052032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080003","WINhealth Gold SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080003-01","Standard Gold On Exchange Plan","78.50%","0.64013808965683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","Individual","No","83-0309681","53189WY0070009","WINhealth Bronze-D","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Only for sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","Individual","No","83-0309681","53189WY0070009","WINhealth Bronze-D","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Only for sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070009-03","Limited Cost Sharing Plan Variation","61.30%","0.614531815052032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-05","87% AV Level Silver Plan","86.40%","0.845970273017883","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","4","53189","WY","Individual","No","83-0309681","53189WY0070004","WINhealth Silver","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070004-06","94% AV Level Silver Plan","93.10%","0.915770649909973","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","7","53189","WY","Individual","No","83-0309681","53189WY0070007","WINhealth Platinum","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070007-03","Limited Cost Sharing Plan Variation","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","Individual","No","83-0309681","53189WY0070005","WINhealth Gold HSA","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070005-00","Standard Gold Off Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080008","WINhealth Silver-D-HSA-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080008-00","Standard Silver Off Exchange Plan","71.40%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080008","WINhealth Silver-D-HSA-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080008-01","Standard Silver On Exchange Plan","71.40%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350001","BCBS Premier 1, MSP 1,000/2,750","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350002","BCBS Premier 2, MSP 500/4,000","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","17","38344","AK","Individual","No","91-0499247","38344AK0600008","Blue Cross Blue Shield Select 6350, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028283.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600008-03","Limited Cost Sharing Plan Variation",,"0.619306743144989","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028246.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570001-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570001","Blue Cross Blue Shield Plus 5250 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028246.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-03","Limited Cost Sharing Plan Variation","71.64%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-05","87% AV Level Silver Plan","86.30%","0.805943071842194","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090003","GHC Silver Standard POS","94529WI009","7558364783","WIN002","WIS001","WIF003","New","POS","Silver","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop22&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090003-01","Standard Silver On Exchange Plan",,"0.711404383182526","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$470","$150","$4,000","$300","$60","$80","9"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","Individual","No","39-1199466","94529WI0210016","GHC Silver Standard HMO Benefit Arch Plan","94529WI021","7558364783","WIN001","WIS002","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210016-06","94% AV Level Silver Plan","93.20%","0.940634667873383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,115","$4,230",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090004","GHC Bronze Basic POS","94529WI009","7558364783","WIN002","WIS001","WIF007","New","POS","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop23&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090004-00","Standard Bronze Off Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","10"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","6","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0090004","GHC Bronze Basic POS","94529WI009","7558364783","WIN002","WIS001","WIF007","New","POS","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our POS plans provide coverage for those locations at a higher cost sharing amount.","No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop23&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_POS_Member_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0090004-01","Standard Bronze On Exchange Plan",,"0.619829416275024","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$900","$60","$80","11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","7","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220013","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220013-00","Standard Platinum Off Exchange Plan","90.30%","0.877367258071899","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$280","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","7","94529","WI","Individual","No","39-1199466","94529WI0210013","GHC Catastrophic Care HMO","94529WI021","7558364783","WIN001","WIS002","WIF008","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","3","3","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind16&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$6,350","$0","$0","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","7","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220013","GHC Platinum Preferred HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF001","New","HMO","Platinum","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop13&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220013-01","Standard Platinum On Exchange Plan","90.30%","0.877367258071899","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$500","$150","$1,000","$0","$280","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","7","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220014","GHC Gold Plated HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220014-00","Standard Gold Off Exchange Plan","80.80%","0.783611416816711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","7","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220014","GHC Gold Plated HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF002","New","HMO","Gold","Yes","Both","Yes","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop14&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220014-01","Standard Gold On Exchange Plan","80.80%","0.783611416816711","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220015","GHC Silver Standard HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220015-00","Standard Silver Off Exchange Plan","68.30%","0.68016254901886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","8","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220015","GHC Silver Standard HMO Benefit Arch Plan","94529WI022","7558364783","WIN001","WIS001","WIF009","New","HMO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop15&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220015-01","Standard Silver On Exchange Plan","68.30%","0.68016254901886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110006","GHC Gold Plated PPO Benefit Arch","94529WI011","7558364783","WIN002","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop25&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110006-00","Standard Gold Off Exchange Plan","80.80%","0.792330801486969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,500","$3,000","80%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610001","Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028279.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610001-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-05","87% AV Level Silver Plan",,"0.869228065013886","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-06","94% AV Level Silver Plan",,"0.941823601722717","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$400","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-01","Standard Silver On Exchange Plan","70.24%","0.702429592609406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-03","Limited Cost Sharing Plan Variation","70.24%","0.702429592609406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610001","Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028279.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610001-03","Limited Cost Sharing Plan Variation",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-01","Standard Silver On Exchange Plan",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-03","Limited Cost Sharing Plan Variation",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-04","73% AV Level Silver Plan",,"0.723487317562103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-05","87% AV Level Silver Plan",,"0.863225042819977","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$1,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","Individual","No","39-1199466","94529WI0210008","GHC Bronze HSA-Eligible HMO Plan","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$4,000","$0","$0","$150","$4,000","$0","$0","$80","6"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110006","GHC Gold Plated PPO Benefit Arch","94529WI011","7558364783","WIN002","WIS001","WIF002","New","PPO","Gold","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop25&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110006-01","Standard Gold On Exchange Plan","80.80%","0.792330801486969","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,500","$3,000","80%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$0","$0","$150","$3,000","$0","$0","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","9","94529","WI","Individual","No","39-1199466","94529WI0210008","GHC Bronze HSA-Eligible HMO Plan","94529WI021","7558364783","WIN001","WIS002","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=ind8&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_Individual_Policy_Final.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0210008-03","Limited Cost Sharing Plan Variation",,"0.592859089374542","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$590","$150","$4,000","$320","$110","$80","7"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110007","GHC Silver Standard PPO Benefit Arch Plan","94529WI011","7558364783","WIN002","WIS001","WIF009","New","PPO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop26&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110007-00","Standard Silver Off Exchange Plan","68.30%","0.685695588588715","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$6,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","10","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0110007","GHC Silver Standard PPO Benefit Arch Plan","94529WI011","7558364783","WIN002","WIS001","WIF009","New","PPO","Silver","Yes","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","GHC-SCW issues employer contracts to employer groups located in service area of Dane County.  Employer groups may have locations outside of Dane County.  Our PPO Plans provide coverage for those locations at a higher cost sharing amount.","Yes","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop26&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_PPO_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0110007-01","Standard Silver On Exchange Plan","68.30%","0.685695588588715","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$6,000","30%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$350","$150","$4,000","$260","$90","$80","5"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI022","7558364783","WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220011-00","Standard Bronze Off Exchange Plan",,"0.611993968486786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$370","$160","$80","4"
"2014","WI","94529","HIOS","10","2014-03-19 07:06:49","11","94529","WI","SHOP (Small Group)","No","39-1199466","94529WI0220011","GHC Bronze Basic HMO, $50 Tier 1 RX","94529WI022","7558364783","WIN001","WIS001","WIF006","New","HMO","Bronze","No","Both","No","Yes","Allergy, Asthma, Audiology, Cardiovascular, Dermatology, ENT/Otolaryngology, Endocrinology, Gastroenterology, General Surgery, Geriatrics, Hematology, Immunology, Infectious Diseases, Nephrology, Neurology , Neurosurgery, Medical Oncology, Ophthalmology, Orthopedics, Pain Management, Peripheral Vascular, Perinatology, Plastic Surgery, Pulmonology, Radiation Oncology, Rheumatology, Speech Therapy, Spine Medicine, Sports Medicine, Transplant Surgery/Medicine, Urology, Vascular Surgery, All out of area specialty care","Prior Authorization, Medically Necessary/Medical Necessity, Act of War, Ongoing Medical Necessity, US Government Health Facilities, Experimental/ Investigational Treatment, Service Before Effective Date, Service After Termination Date, Services While Incarcerated, Any Charge for an Appointment a Member does not Attend, Services for Injuries Incurred During the Commission of a Crime",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","https://ghcscw.com/xsp/Ratemaker/HIXExchange.asp?plan=shop11&year=2014","https://ghcscw.com/welcome","https://ghcscw.com/SiteCollectionDocuments/Certificates/2014_HMO_Group_Certificate.pdf","https://ghcscw.com/SiteCollectionDocuments/GHC-SCW_Marketplace_Complete_Formulary.pdf","94529WI0220011-01","Standard Bronze On Exchange Plan",,"0.611993968486786","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$590","$150","$4,000","$370","$160","$80","5"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080001","Marketplace BlueSelect Gold for Employer Groups","11269WY008",,"WYN001","WYS001","WYF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0080001-01","Standard Gold On Exchange Plan","78.01%","0.780111849308014","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,"4"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070003","Marketplace BlueSelect Bronze for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070003-01","Standard Bronze On Exchange Plan","61.85%","0.618507981300354","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,"4"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070003","Marketplace BlueSelect Bronze for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080002","Marketplace BlueSelect Silver for Employer Groups","11269WY008",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0080002-01","Standard Silver On Exchange Plan","70.03%","0.700286328792572","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","25%",,,,"$4,500","$9,000","$6,500","$13,000",,,,,,,,,"5"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070003","Marketplace BlueSelect Bronze for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070003-03","Limited Cost Sharing Plan Variation","61.85%","0.618507981300354","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$8,000","$15,000","$13,500","$26,000",,,,,,,,,"6"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080003","Marketplace BlueSelect Bronze for Employer Groups","11269WY008",,"WYN001","WYS001","WYF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0080003-01","Standard Bronze On Exchange Plan","61.68%","0.616817772388458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"$6,500","$13,000","$10,500","$11,000",,,,,,,,,"6"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070001","Marketplace BlueSelect Gold for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070001-01","Standard Gold On Exchange Plan","78.01%","0.780111849308014","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,"7"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070001","Marketplace BlueSelect Gold for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070001","Marketplace BlueSelect Gold for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070001-03","Limited Cost Sharing Plan Variation","78.01%","0.780111849308014","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$3,500","$7,000","$4,500","$9,000",,,,,,,,,"9"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-01","Standard Silver On Exchange Plan","68.58%","0.685770511627197","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","25%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"10"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-03","Limited Cost Sharing Plan Variation","68.58%","0.685770511627197","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","25%",,,,"$5,000","$10,000","$7,500","$15,000",,,,,,,,,"12"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-04","73% AV Level Silver Plan","72.26%","0.722632050514221","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","25%",,,,"$5,000","$10,000","$7,100","$14,200",,,,,,,,,"13"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-05","87% AV Level Silver Plan","86.62%","0.866226613521576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","$17,950","$29,900",,,,,,,,,,,,,,,,,,,,,"$400","$800","25%",,,,"$5,000","$10,000","$5,400","$10,800",,,,,,,,,"14"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","1","11269","WY","Individual","No","83-0231011","11269WY0070002","Marketplace BlueSelect Silver for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","6","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070002-06","94% AV Level Silver Plan","93.66%","0.936602771282196","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","$1,700",,,"$12,700","$25,400","$13,550","$27,100",,,,,,,,,,,,,,,,,,,,,"$100","$200","25%",,,,"$5,000","$10,000","$5,100","$10,200",,,,,,,,,"15"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","2","11269","WY","SHOP (Small Group)","No","83-0231011","11269WY0080004","Marketplace BlueSelect Bronze HSA for Employer Groups","11269WY008",,"WYN001","WYS001","WYF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0080004-01","Standard Bronze On Exchange Plan","59.91%","0.599059820175171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000","50%",,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,"4"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","2","11269","WY","Individual","No","83-0231011","11269WY0070004","Marketplace BlueSelect Bronze HSA for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070004-01","Standard Bronze On Exchange Plan","59.91%","0.599059820175171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000","50%",,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,"4"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","2","11269","WY","Individual","No","83-0231011","11269WY0070004","Marketplace BlueSelect Bronze HSA for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","2","11269","WY","Individual","No","83-0231011","11269WY0070004","Marketplace BlueSelect Bronze HSA for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070004-03","Limited Cost Sharing Plan Variation","59.91%","0.599059820175171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$6,000","50%",,,,"$6,000","$12,000","$9,500","$18,000",,,,,,,,,"6"
"2014","WY","11269","HIOS","6","2013-09-14 08:04:57","3","11269","WY","Individual","No","83-0231011","11269WY0070005","Marketplace BlueSelect Catastrophic for Individuals and Families","11269WY007",,"WYN001","WYS001","WYF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","3","2014-01-01",,"Yes","BlueCard® Worldwide Program – Have access to doctors and hospitals in more than 200 countries and territories around the world through the BlueCard® Worldwide Program.  Twenty four hours a day, seven days a week information can be obtained by calling 1-800-810-BLUE (2583) or on-line at www.bcbs.com/bluecardworldwide.","Yes","BlueCard Network - Provides access to our Out-of-Area Network Program, when they must seek health care out of state.  This network includes discounts, negotiated reimbursement levels, and protection from balance billing.","Yes","http://www.WyomingBlueSBC.com/marketplace","http://www.bcbswy.com/pay","http://www.bcbswy.com/shopping","https://www.bcbswy.com/docs/pharmacy/2278_WY_Preferred_DL_Formulary.pdf","11269WY0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","50%",,,,"$8,850","$17,700","$15,200","$30,400",,,,,,,,,"4"
"2014","WY","37378","HIOS","1","2013-06-06 10:50:48","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010001","DentalConnect","37378WY001",,"WYN001","WYS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"37378WY0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","37378","HIOS","1","2013-06-06 10:50:48","1","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010002","DentalConnect","37378WY001",,"WYN001","WYS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"37378WY0010002-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","37378","HIOS","1","2013-06-06 10:50:48","2","37378","WY","SHOP (Small Group)","Yes","35-0472300","37378WY0010003","DentalConnect","37378WY001",,"WYN001","WYS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.09",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"37378WY0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","1","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0010001","Guardian Pediatric Advantage","38921WY001",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0010001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","1","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0010001","Guardian Pediatric Advantage","38921WY001",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0010001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","1","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0020001","Guardian Pediatric Essentials","38921WY002",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0020001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","1","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0020001","Guardian Pediatric Essentials","38921WY002",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0020001-01","Standard Low On Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","2","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0030001","Guardian Family Advantage Plus","38921WY003",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0030001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","2","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0030001","Guardian Family Advantage Plus","38921WY003",,"WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.04",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0030001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","38921","HIOS","5","2013-09-02 11:39:25","3","38921","WY","SHOP (Small Group)","Yes","13-5123390","38921WY0050001","Guardian Family Essentials Plus","38921WY005",,"WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage Available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"38921WY0050001-00","Standard Low Off Exchange Plan","70.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","Individual","Yes","95-6042390","47731WY0030004","BESTOne Dental Plus - Gold","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47731WY0030004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020004","BEST Dental Plus - Gold","47731WY002",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Plus_Plan_(Gold).pdf",,"47731WY0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","3","47731","WY","Individual","Yes","95-6042390","47731WY0030004","BESTOne Dental Plus - Gold","47731WY003",,"WYN001","WYS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47731WY0030004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020005","BEST Dental Plus - Silver","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.41",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Plus_Plan_(Silver).pdf",,"47731WY0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","Individual","Yes","95-6042390","47731WY0030005","BESTOne Dental Plus - Silver","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Denta_Plus_Plan_Silver).pdf",,"47731WY0030005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","Individual","Yes","95-6042390","47731WY0030005","BESTOne Dental Plus - Silver","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Denta_Plus_Plan_Silver).pdf",,"47731WY0030005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020005","BEST Dental Plus - Silver","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$60.41",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Plus_Plan_(Silver).pdf",,"47731WY0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","Individual","Yes","95-6042390","47731WY0030006","BESTOne Dental Basic - Silver","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47731WY0030006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020006","BEST Dental Basic - Silver","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Basic_Plan_(Silver).pdf",,"47731WY0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","SHOP (Small Group)","Yes","95-6042390","47731WY0020006","BEST Dental Basic - Silver","47731WY002",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.51",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BEST_Dental_Basic_Plan_(Silver).pdf",,"47731WY0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","47731","HIOS","9","2014-03-19 07:06:49","4","47731","WY","Individual","Yes","95-6042390","47731WY0030006","BESTOne Dental Basic - Silver","47731WY003",,"WYN001","WYS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/WY/pdf/WY_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47731WY0030006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","1","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080001","WINhealth Bronze-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent care withouth preauth, non-emergent care requires preauth","Yes","Only in cases of sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080001-00","Standard Bronze Off Exchange Plan","61.30%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","1","53189","WY","Individual","No","83-0309681","53189WY0070001","WINhealth Catastrophic","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only sole source coverage at tier 1","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$0","$0","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","1","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080001","WINhealth Bronze-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent care withouth preauth, non-emergent care requires preauth","Yes","Only in cases of sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080001-01","Standard Bronze On Exchange Plan","61.30%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080002","WINhealth Silver-HSA-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080002-00","Standard Silver Off Exchange Plan","70.10%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","Individual","No","83-0309681","53189WY0070002","WINhealth Bronze","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-ermergent care  requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070002-00","Standard Bronze Off Exchange Plan","61.30%","0.614286005496979","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080002","WINhealth Silver-HSA-SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080002-01","Standard Silver On Exchange Plan","70.10%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","Individual","No","83-0309681","53189WY0070002","WINhealth Bronze","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-ermergent care  requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070002-01","Standard Bronze On Exchange Plan","61.30%","0.614286005496979","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","Individual","No","83-0309681","53189WY0070002","WINhealth Bronze","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-ermergent care  requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","14","53189","WY","Individual","No","83-0309681","53189WY0070014","WINhealth Platinum-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070014-01","Standard Platinum On Exchange Plan","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","14","53189","WY","Individual","No","83-0309681","53189WY0070014","WINhealth Platinum-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","14","53189","WY","Individual","No","83-0309681","53189WY0070014","WINhealth Platinum-D","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Platinum","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070014-03","Limited Cost Sharing Plan Variation","88.10%","0.848667442798615","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$750","$485","$420","$0","$750","$280","$260","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","2","53189","WY","Individual","No","83-0309681","53189WY0070002","WINhealth Bronze","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-ermergent care  requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070002-03","Limited Cost Sharing Plan Variation","61.30%","0.614286005496979","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","3","53189","WY","Individual","No","83-0309681","53189WY0070009","WINhealth Bronze-D","53189WY007",,"WYN001","WYS003","WYF001","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Only for sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070009-00","Standard Bronze Off Exchange Plan","61.30%","0.614531815052032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$4,000","$0","$700","$0","$4,000","$0","$1,000","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","Individual","No","83-0309681","53189WY0070005","WINhealth Gold HSA","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070005-01","Standard Gold On Exchange Plan","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","Individual","No","83-0309681","53189WY0070005","WINhealth Gold HSA","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","8","53189","WY","Individual","No","83-0309681","53189WY0070005","WINhealth Gold HSA","53189WY007",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070005-03","Limited Cost Sharing Plan Variation","79.60%","0.751767933368683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$0","$410","$0","$1,300","$0","$400","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","9","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080009","WINhealth Silver-D SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080009-00","Standard Silver Off Exchange Plan","70.50%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","9","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080009","WINhealth Silver-D SG","53189WY008",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01","2014-12-31","Yes","Emergent care without preauth. Non-emergent care requires preauth","Yes","Only when sole source","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080009-01","Standard Silver On Exchange Plan","70.50%","0.645716488361359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080010","WINhealth Gold D HSA SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080010-00","Standard Gold Off Exchange Plan","78.20%","0.767684698104858","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-00","Standard Silver Off Exchange Plan","70.10%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080010","WINhealth Gold D HSA SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080010-01","Standard Gold On Exchange Plan","78.20%","0.767684698104858","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-01","Standard Silver On Exchange Plan","70.10%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-03","Limited Cost Sharing Plan Variation","70.10%","0.700544476509094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$0","$500","$0","$2,500","$0","$146","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-04","73% AV Level Silver Plan","73.00%","0.730297029018402","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-05","87% AV Level Silver Plan","87.00%","0.880020380020142","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","10","53189","WY","Individual","No","83-0309681","53189WY0070010","WINhealth Silver HSA-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070010-06","94% AV Level Silver Plan","93.00%","0.933893859386444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","4","83964","WY","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual and Family Preferred Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$52.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109999.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010004-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0930003","Blue Cross Blue Shield Select 1000, a Multi-State Plan","38344AK093",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.979623250018324",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028524.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0930003-01","Standard Gold On Exchange Plan",,"0.794752836227417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-00","Standard Silver Off Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","4"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080011","WINhealth Gold-D SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080011-00","Standard Gold Off Exchange Plan","78.50%","0.64013808965683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600002","Blue Cross Blue Shield Select 1000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028262.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600002-03","Limited Cost Sharing Plan Variation",,"0.789890766143799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600003","Blue Cross Blue Shield Select 1500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028264.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600003-01","Standard Gold On Exchange Plan",,"0.781128227710724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-01","Standard Silver On Exchange Plan","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","SHOP (Small Group)","No","83-0309681","53189WY0080011","WINhealth Gold-D SG","53189WY008",,"WYN001","WYS003","WYF003","New","HMO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,,,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0080011-01","Standard Gold On Exchange Plan","78.50%","0.64013808965683","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-03","Limited Cost Sharing Plan Variation","70.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$1,220","$420","$0","$1,700","$640","$260","$0","7"
"2014","WY","53189","HIOS","7","2014-01-15 07:08:32","11","53189","WY","Individual","No","83-0309681","53189WY0070011","WINhealth Silver-D","53189WY007",,"WYN001","WYS003","WYF002","New","HMO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Non-emergent care requires preauth","Yes","Sole source only","Yes","http://winhealthplans.com/summary-benefit-coverage",,"http://www.winhealthplans.com/about-us","http://www.winhealthplans.com/media/2014-formulary.pdf","53189WY0070011-04","73% AV Level Silver Plan","73.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","1","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020001","Delta Dental Premier Basic Pediatric Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$37.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110004.aspx","https://secure.deltadentalwy.org/ffm/default.aspx","http://www.deltadentalwy.org/employers/",,"83964WY0020001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","1","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020001","Delta Dental Premier Basic Pediatric Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$37.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110004.aspx","https://secure.deltadentalwy.org/ffm/default.aspx","http://www.deltadentalwy.org/employers/",,"83964WY0020001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","1","83964","WY","Individual","Yes","83-0209667","83964WY0010001","Delta Dental Individual Basic Pediatric Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$43.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109998.aspx","https://secure.deltadentalwy.org/ffm/default.aspx","http://www.deltadentalwy.org/individualoptions/",,"83964WY0010001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","2","83964","WY","Individual","Yes","83-0209667","83964WY0010002","Delta Dental Individual Preferred Pediatric Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$52.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109997.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-05","87% AV Level Silver Plan",,"0.868679940700531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-06","94% AV Level Silver Plan",,"0.942135095596313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$400","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-05","87% AV Level Silver Plan",,"0.871685922145844","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-06","94% AV Level Silver Plan",,"0.933216869831085","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","2","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020002","Delta Dental Premier Preferred Pediatric Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18",,,,,"Allows Child-Only",,,,"$44.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110003.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020002-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","2","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020002","Delta Dental Premier Preferred Pediatric Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18",,,,,"Allows Child-Only",,,,"$44.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110003.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020002-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","8","38344","AK","Individual","No","91-0499247","38344AK0640003","Blue Cross Blue Shield Select 6350 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.958",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028292.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640003-01","Standard Bronze On Exchange Plan",,"0.619306743144989","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","8","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980011","Blue Cross Blue Shield Plus 5500, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF013","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.971573208722741",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028490.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980011-01","Standard Bronze On Exchange Plan",,"0.615731298923492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","8","38344","AK","Individual","No","91-0499247","38344AK0640003","Blue Cross Blue Shield Select 6350 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.958",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028292.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-03","Limited Cost Sharing Plan Variation",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-04","73% AV Level Silver Plan",,"0.723487317562103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","2","83964","WY","Individual","Yes","83-0209667","83964WY0010002","Delta Dental Individual Preferred Pediatric Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18.",,,,,"Allows Child-Only",,,,"$52.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109997.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010002-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","3","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020003","Delta Dental Premier Basic Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$37.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110006.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020003-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","6","38344","AK","Individual","No","91-0499247","38344AK0650003","Blue Cross Blue Shield Plus 6350 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9559",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028260.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","6","38344","AK","Individual","No","91-0499247","38344AK0650003","Blue Cross Blue Shield Plus 6350 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9559",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028260.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650003-03","Limited Cost Sharing Plan Variation",,"0.618990540504456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-01","Standard Silver On Exchange Plan","69.78%","0.697821319103241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogoldnational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/ppogoldnational","www.ibx.com/ffm/formulary2","31609PA0140001-03","Limited Cost Sharing Plan Variation","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-01","Standard Silver On Exchange Plan","71.64%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","3","83964","WY","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual and Family Basic Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$43.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d110000.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010003-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","3","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020003","Delta Dental Premier Basic Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$37.70",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110006.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020003-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","5","38344","AK","Individual","No","91-0499247","38344AK0640001","Blue Cross Blue Shield Select 1500 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9676",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028285.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640001-03","Limited Cost Sharing Plan Variation",,"0.781128227710724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","6","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980005","Blue Cross Blue Shield Plus 1700, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF010","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.977121724959258",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028494.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980005-01","Standard Silver On Exchange Plan",,"0.718562126159668","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"$3,400","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","16","38344","AK","Individual","No","91-0499247","38344AK0650001","Blue Cross Blue Shield Plus 1500 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9666",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028254.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650001-03","Limited Cost Sharing Plan Variation",,"0.781610012054443","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","17","38344","AK","Individual","No","91-0499247","38344AK0600008","Blue Cross Blue Shield Select 6350, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028283.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600008-01","Standard Bronze On Exchange Plan",,"0.619306743144989","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","17","38344","AK","Individual","No","91-0499247","38344AK0600008","Blue Cross Blue Shield Select 6350, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028283.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross� Gold, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.946207110507203",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410002-01","Standard Gold On Exchange Plan","78.00%","0.808510422706604","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","20%",,,,"$300","$600","Not Applicable","Not Applicable","$150","$500","$1,100","$150","$150","$180","$890","$40","10"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross� Gold, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.946207110507203",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$40","11"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410002","Blue Cross� Gold, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.946207110507203",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410002-03","Limited Cost Sharing Plan Variation","78.00%","0.808510422706604","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","20%",,,,"$300","$600","Not Applicable","Not Applicable","$150","$500","$1,100","$150","$150","$180","$890","$40","12"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-01","Standard Silver On Exchange Plan","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-03","Limited Cost Sharing Plan Variation","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-04","73% AV Level Silver Plan","73.39%","0.738157749176025","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-05","87% AV Level Silver Plan","86.13%","0.862549245357513","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","3","83964","WY","Individual","Yes","83-0209667","83964WY0010003","Delta Dental Individual and Family Basic Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$43.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d110000.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010003-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","4","83964","WY","Individual","Yes","83-0209667","83964WY0010004","Delta Dental Individual and Family Preferred Plan","83964WY001","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$52.84",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/IndividualOptions/HealthCareReformIndividual/d109999.aspx",,"http://www.deltadentalwy.org/individualoptions/",,"83964WY0010004-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","4","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020004","Delta Dental Premier Preferred Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$45.42",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110005.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020004-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WY","83964","HIOS","7","2013-09-14 08:04:57","4","83964","WY","SHOP (Small Group)","Yes","83-0209667","83964WY0020004","Delta Dental Premier Preferred Plan","83964WY002","7609879839","WYN001","WYS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$45.42",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalwy.org/Employers/HealthCareReformSmallgroup/d110005.aspx",,"http://www.deltadentalwy.org/employers/",,"83964WY0020004-01","Standard High On Exchange Plan","84.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600002","Blue Cross Blue Shield Select 1000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028262.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600002-01","Standard Gold On Exchange Plan",,"0.789890766143799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600002","Blue Cross Blue Shield Select 1000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028262.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600003","Blue Cross Blue Shield Select 1500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028264.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","1","38344","AK","Individual","No","91-0499247","38344AK0600003","Blue Cross Blue Shield Select 1500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028264.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600003-03","Limited Cost Sharing Plan Variation",,"0.781128227710724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-03","Limited Cost Sharing Plan Variation","70.97%","0.716426849365234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-04","73% AV Level Silver Plan","72.99%","0.735651254653931","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-05","87% AV Level Silver Plan","86.11%","0.862908780574799","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-06","94% AV Level Silver Plan","93.08%","0.932125985622406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940002-01","Standard Gold On Exchange Plan","79.97%","0.804724991321564","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0930004","Blue Cross Blue Shield Select 1500, a Multi-State Plan","38344AK093",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.979111442971813",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028525.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0930004-01","Standard Gold On Exchange Plan",,"0.789163172245026","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610001","Blue Cross Blue Shield Select 5250 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028279.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","2","38344","AK","Individual","No","91-0499247","38344AK0610002","Blue Cross Blue Shield Select 2500 HSA, a Multi-State Plan","38344AK061",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028273.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0610002-06","94% AV Level Silver Plan",,"0.937364161014557","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","3","38344","AK","Individual","No","91-0499247","38344AK0620002","Blue Cross Blue Shield Plus 1000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028228.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620002-01","Standard Gold On Exchange Plan",,"0.786464691162109","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","3","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0930005","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK093",,"AKN001","AKS001","AKF007","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.977807934860701",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028526.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0930005-01","Standard Silver On Exchange Plan",,"0.718149900436401","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","3","38344","AK","Individual","No","91-0499247","38344AK0620002","Blue Cross Blue Shield Plus 1000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028228.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","3","38344","AK","Individual","No","91-0499247","38344AK0620002","Blue Cross Blue Shield Plus 1000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028228.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620002-03","Limited Cost Sharing Plan Variation",,"0.786464691162109","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630001","Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028247.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630001-01","Standard Bronze On Exchange Plan",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0950001","Blue Cross Blue Shield Select 1700 HSA, a Multi-State Plan","38344AK095",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.976978178957393",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028489.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0950001-01","Standard Silver On Exchange Plan",,"0.719860076904297","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$9,200","$18,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"$3,400","$6,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630001","Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028247.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0950003","Blue Cross Blue Shield Select 3850 HSA, a Multi-State Plan","38344AK095",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.972149869765578",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028488.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0950003-01","Standard Bronze On Exchange Plan",,"0.619450092315674","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,850","$7,700","20%",,,,"$7,700","$15,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630001","Blue Cross Blue Shield Plus 5250 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028247.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630001-03","Limited Cost Sharing Plan Variation",,"0.619937121868134","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","0%",,,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-01","Standard Silver On Exchange Plan",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-03","Limited Cost Sharing Plan Variation",,"0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-04","73% AV Level Silver Plan",,"0.723487317562103","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-05","87% AV Level Silver Plan",,"0.863225042819977","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$1,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","4","38344","AK","Individual","No","91-0499247","38344AK0630002","Blue Cross Blue Shield Plus 2500 HSA, a Multi-State Plan","38344AK063",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028240.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0630002-06","94% AV Level Silver Plan",,"0.937364161014557","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","5","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980003","Blue Cross Blue Shield Plus 1000, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF005","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.979169819887998",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028492.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980003-01","Standard Gold On Exchange Plan",,"0.791901886463165","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","5","38344","AK","Individual","No","91-0499247","38344AK0640001","Blue Cross Blue Shield Select 1500 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9676",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028285.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640001-01","Standard Gold On Exchange Plan",,"0.781128227710724","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","5","38344","AK","Individual","No","91-0499247","38344AK0640001","Blue Cross Blue Shield Select 1500 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9676",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028285.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","5","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980004","Blue Cross Blue Shield Plus Gold 1500, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF001","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.978793482029354",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028493.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980004-01","Standard Gold On Exchange Plan",,"0.786754369735718","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","6","38344","AK","Individual","No","91-0499247","38344AK0650003","Blue Cross Blue Shield Plus 6350 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9559",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028260.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650003-01","Standard Bronze On Exchange Plan",,"0.618990540504456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980006","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF014","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.976990480993507",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028495.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980006-01","Standard Silver On Exchange Plan",,"0.71899402141571","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-03","Limited Cost Sharing Plan Variation","69.78%","0.697821319103241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-04","73% AV Level Silver Plan","72.20%","0.721975564956665","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-05","87% AV Level Silver Plan","86.00%","0.856655180454254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","7","38344","AK","Individual","No","91-0499247","38344AK0640002","Blue Cross Blue Shield Select 3000 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"0.9643",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028290.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640002-06","94% AV Level Silver Plan","93.21%","0.93210768699646","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$600","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","8","38344","AK","Individual","No","91-0499247","38344AK0640003","Blue Cross Blue Shield Select 6350 Package VH, a Multi-State Plan","38344AK064",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.958",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028292.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0640003-03","Limited Cost Sharing Plan Variation",,"0.619306743144989","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK0980012","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK098",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"0.972029379213201",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028491.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0980012-01","Standard Bronze On Exchange Plan",,"0.618990540504456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-01","Standard Silver On Exchange Plan",,"0.718149900436401","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-03","Limited Cost Sharing Plan Variation",,"0.718149900436401","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600004","Blue Cross Blue Shield Select 2000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF005","New","PPO","Silver","No","On the Exchange","No","No",,,"$187.32","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028269.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600004-04","73% AV Level Silver Plan",,"0.739233553409576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-01","Standard Silver On Exchange Plan","69.78%","0.697821319103241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-03","Limited Cost Sharing Plan Variation","69.78%","0.697821319103241","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-04","73% AV Level Silver Plan","72.48%","0.724782466888428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-05","87% AV Level Silver Plan","86.03%","0.856655180454254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","9","38344","AK","Individual","No","91-0499247","38344AK0600006","Blue Cross Blue Shield Select 3000, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$195.93","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028278.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600006-06","94% AV Level Silver Plan","93.21%","0.93210768699646","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$600","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","10","38344","AK","SHOP (Small Group)","No","91-0499247","38344AK1000003","Blue Cross Blue Shield Plus 3850 HSA, a Multi-State Plan","38344AK100",,"AKN001","AKS001","AKF002","New","PPO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes",,,"0.970583567007037",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you�re outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028496.pdf",,,"http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK1000003-01","Standard Bronze On Exchange Plan",,"0.619450092315674","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,850","$7,700","20%",,,,"$7,700","$15,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","10","38344","AK","Individual","No","91-0499247","38344AK0600007","Blue Cross Blue Shield Select 5500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028281.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600007-01","Standard Bronze On Exchange Plan",,"0.613848924636841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","10","38344","AK","Individual","No","91-0499247","38344AK0600007","Blue Cross Blue Shield Select 5500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028281.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","10","38344","AK","Individual","No","91-0499247","38344AK0600007","Blue Cross Blue Shield Select 5500, a Multi-State Plan","38344AK060",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028281.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0600007-03","Limited Cost Sharing Plan Variation",,"0.613848924636841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-01","Standard Silver On Exchange Plan",,"0.718697726726532","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-03","Limited Cost Sharing Plan Variation",,"0.718697726726532","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620004","Blue Cross Blue Shield Plus 2000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","No","On the Exchange","No","No",,,"$186.33","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028235.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620004-04","73% AV Level Silver Plan",,"0.739847004413605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-04","73% AV Level Silver Plan","72.36%","0.723591268062592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-05","87% AV Level Silver Plan","86.20%","0.859080374240875","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","11","38344","AK","Individual","No","91-0499247","38344AK0620006","Blue Cross Blue Shield Plus 3000, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028245.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620006-06","94% AV Level Silver Plan","93.02%","0.930249750614166","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$600","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","12","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028230.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-01","Standard Gold On Exchange Plan",,"0.781610012054443","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-04","73% AV Level Silver Plan","73.12%","0.734771132469177","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-05","87% AV Level Silver Plan","86.10%","0.862314343452454","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-06","94% AV Level Silver Plan","93.07%","0.931488215923309","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","2","49046","GA","Individual","No","58-1638390","49046GA0610002","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN002","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610002-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","2","49046","GA","Individual","No","58-1638390","49046GA0610002","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN002","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","2","49046","GA","Individual","No","58-1638390","49046GA0610002","Blue Cross and Blue Shield Healthcare Plan of Georgia Gold DirectAccess, a Multi-State Plan","49046GA061",,"GAN002","GAS001","GAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610002-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380001-01","Standard Gold On Exchange Plan",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","4"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-05","87% AV Level Silver Plan","86.40%","0.860804855823517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$400","$1,200","20%",,,,"$4,000","$12,000","$4,400","$13,200","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$400","$12","$1,372","$150","$400","$480","$174","$79","11"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-06","94% AV Level Silver Plan","93.70%","0.937390029430389","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,150","$4,300",,,"$12,800","$25,600","$14,950","$29,900","$100","$300","0%",,,,"$4,000","$12,000","$4,100","$12,300","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$100","$12","$0","$150","$100","$480","$0","$79","12"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","12","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028230.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","12","38344","AK","Individual","No","91-0499247","38344AK0620003","Blue Cross Blue Shield Plus 1500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028230.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620003-03","Limited Cost Sharing Plan Variation",,"0.781610012054443","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","13","38344","AK","Individual","No","91-0499247","38344AK0620007","Blue Cross Blue Shield Plus 5500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028249.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620007-01","Standard Bronze On Exchange Plan",,"0.616936385631561","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","13","38344","AK","Individual","No","91-0499247","38344AK0620007","Blue Cross Blue Shield Plus 5500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028249.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","13","38344","AK","Individual","No","91-0499247","38344AK0620007","Blue Cross Blue Shield Plus 5500, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF007","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028249.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620007-03","Limited Cost Sharing Plan Variation",,"0.616936385631561","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","14","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028252.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620008-01","Standard Bronze On Exchange Plan",,"0.618990540504456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","14","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028252.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","14","38344","AK","Individual","No","91-0499247","38344AK0620008","Blue Cross Blue Shield Plus 6350, a Multi-State Plan","38344AK062",,"AKN001","AKS001","AKF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028252.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0620008-03","Limited Cost Sharing Plan Variation",,"0.618990540504456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-01","Standard Silver On Exchange Plan","70.24%","0.702429592609406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-03","Limited Cost Sharing Plan Variation","70.24%","0.702429592609406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-04","73% AV Level Silver Plan","72.36%","0.723591268062592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-05","87% AV Level Silver Plan","86.20%","0.859080374240875","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","15","38344","AK","Individual","No","91-0499247","38344AK0650002","Blue Cross Blue Shield Plus 3000 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$190.53","No",,,"Allows Adult and Child-Only",,"No",,,"0.9625",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028259.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650002-06","94% AV Level Silver Plan","93.02%","0.930249750614166","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$600","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","16","38344","AK","Individual","No","91-0499247","38344AK0650001","Blue Cross Blue Shield Plus 1500 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9666",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028254.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650001-01","Standard Gold On Exchange Plan",,"0.781610012054443","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","16","38344","AK","Individual","No","91-0499247","38344AK0650001","Blue Cross Blue Shield Plus 1500 Package VH, a Multi-State Plan","38344AK065",,"AKN001","AKS001","AKF008","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"0.9666",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028254.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0650001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-05","87% AV Level Silver Plan",,"0.863225042819977","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$1,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AK","38344","OPM","2","2013-10-16 19:58:29","18","38344","AK","Individual","No","91-0499247","38344AK0570002","Blue Cross Blue Shield Plus 2500 HSA High, a Multi-State Plan","38344AK057",,"AKN001","AKS001","AKF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$212.29","Yes",,,"Allows Adult and Child-Only",,"No",,,"0.999",,,"0","0","0","2014-01-01",,"Yes","Benefits for covered services received from providers located outside the United States, Puerto Rico and the U.S. Virgin Islands are provided at the highest level of benefits available under the plan.","Yes","If you're outside Alaska and Washington, you may receive covered services from any provider licensed to provide the service.","Yes","https://www.premera.com/documents/028239.pdf",,"https://www.premera.com/documents/007528.pdf","http://client.formularynavigator.com/Search.aspx?siteCode=7918349883","38344AK0570002-06","94% AV Level Silver Plan",,"0.937364161014557","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-01","Standard Silver On Exchange Plan",,"0.719472289085388","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","15%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-03","Limited Cost Sharing Plan Variation",,"0.719472289085388","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","15%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-04","73% AV Level Silver Plan",,"0.73962539434433","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,700","$9,400",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-05","87% AV Level Silver Plan",,"0.875786900520325","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","1","75293","AR","Individual","No","71-0226428","75293AR0350001","Blue Cross Blue Shield 2000, a Multi-State Plan","75293AR035","7427051652","ARN001","ARS001","ARF010","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32013","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0350001-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","2","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross Blue Shield 5000, a Multi-State Plan","75293AR029","7427051652","ARN001","ARS001","ARF046","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0290001-01","Standard Bronze On Exchange Plan",,"0.619454145431519","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","2","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross Blue Shield 5000, a Multi-State Plan","75293AR029","7427051652","ARN001","ARS001","ARF046","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0290001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","2","75293","AR","Individual","No","71-0226428","75293AR0290001","Blue Cross Blue Shield 5000, a Multi-State Plan","75293AR029","7427051652","ARN001","ARS001","ARF046","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0290001-03","Limited Cost Sharing Plan Variation",,"0.619454145431519","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","3","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross Blue Shield 500, a Multi-State Plan","75293AR033","7427051652","ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0330001-01","Standard Gold On Exchange Plan",,"0.814946889877319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","3","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross Blue Shield 500, a Multi-State Plan","75293AR033","7427051652","ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","AR","75293","OPM","4","2014-01-27 10:05:29","3","75293","AR","Individual","No","71-0226428","75293AR0330001","Blue Cross Blue Shield 500, a Multi-State Plan","75293AR033","7427051652","ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0330001-03","Limited Cost Sharing Plan Variation",,"0.814946889877319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-01","Standard Silver On Exchange Plan",,"0.699627578258514","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-03","Limited Cost Sharing Plan Variation",,"0.699627578258514","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","1","76168","DE","Individual","No","51-0020405","76168DE0390001","Blue Cross Blue Shield Shared Cost 3000, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF002","New","EPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390001-04","73% AV Level Silver Plan",,"0.731760799884796","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","2","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF001","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in area","Yes","same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390002-01","Standard Gold On Exchange Plan",,"0.803948640823364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","2","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF001","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in area","Yes","same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","OPM","5","2014-03-21 10:00:27","2","76168","DE","Individual","No","51-0020405","76168DE0390002","Blue Cross Blue Shield Health Savings 1800, a Multi-State Plan","76168DE039",,"DEN001","DES001","DEF001","New","EPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Same as in area","Yes","same as in area","No","https://www.highmark.com/sbc/bcbsde","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","76168DE0390002-03","Limited Cost Sharing Plan Variation",,"0.803948640823364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-01","Standard Silver On Exchange Plan","71.00%","0.715095460414886","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","GA","49046","OPM","2","2013-11-27 09:24:34","1","49046","GA","Individual","No","58-1638390","49046GA0610001","Blue Cross and Blue Shield Healthcare Plan of Georgia Silver DirectAccess, a Multi-State Plan","49046GA061",,"GAN001","GAS001","GAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/ga","http://file.bcbsga.com/03269GAMENHPG.pdf","www.bcbsga.com/GASelectdrugtier4","49046GA0610001-03","Limited Cost Sharing Plan Variation","71.00%","0.715095460414886","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380001","Blue Cross and Blue Shield FreedomPlus, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=FreedomPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380001-03","Limited Cost Sharing Plan Variation",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","6"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-01","Standard Silver On Exchange Plan",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","7"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-03","Limited Cost Sharing Plan Variation","68.10%","0.699648082256317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$500","$850","$150","$1,400","$90","$725","$40","6"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-04","73% AV Level Silver Plan","72.20%","0.740858197212219","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$500","$930","$150","$1,000","$150","$740","$40","7"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-05","87% AV Level Silver Plan","86.10%","0.864746272563934","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$300","$500","$540","$150","$300","$180","$430","$40","8"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-06","94% AV Level Silver Plan","93.10%","0.931599736213684","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","10%",,,,"$350","$700","Not Applicable","Not Applicable","$175","$0","$325","$150","$175","$180","$145","$40","9"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","1","32753","MO","Individual","No","86-0257201","32753MO0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930001-06","94% AV Level Silver Plan","93.08%","0.931559145450592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$1,300","$2,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"$350","$700","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","2","32753","MO","Individual","No","86-0257201","32753MO0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930002-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","2","32753","MO","Individual","No","86-0257201","32753MO0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MO","32753","OPM","2","2013-11-27 09:24:34","2","32753","MO","Individual","No","86-0257201","32753MO0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","32753MO093",,"MON001","MOS001","MOF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/mo","http://file.anthem.com/03261MOMENABS.pdf","www.anthem.com/MOSelectdrugtier4","32753MO0930002-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350001","BCBS Premier 1, MSP 1,000/2,750","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350001","BCBS Premier 1, MSP 1,000/2,750","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","1","36096","IL","Individual","No","36-1236610","36096IL0780004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","2","36096","IL","Individual","No","36-1236610","36096IL0780005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","2","36096","IL","Individual","No","36-1236610","36096IL0780005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IL","36096","OPM","2","2013-10-16 19:58:29","2","36096","IL","Individual","No","36-1236610","36096IL0780005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","36096IL078",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0780005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-01","Standard Silver On Exchange Plan","70.57%","0.710566699504852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-03","Limited Cost Sharing Plan Variation","70.57%","0.710566699504852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,750","$11,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-04","73% AV Level Silver Plan","72.74%","0.730981647968292","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-05","87% AV Level Silver Plan","86.05%","0.861722111701965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","1","17575","IN","Individual","No","35-0781558","17575IN0930001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","17575IN093",,"INN001","INS001","INF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930001-06","94% AV Level Silver Plan","93.04%","0.931224465370178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","2","17575","IN","Individual","No","35-0781558","17575IN0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN002","INS001","INF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930002-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","2","17575","IN","Individual","No","35-0781558","17575IN0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN002","INS001","INF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IN","17575","OPM","2","2013-11-27 09:24:34","2","17575","IN","Individual","No","35-0781558","17575IN0930002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","17575IN093",,"INN002","INS001","INF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/in","http://file.anthem.com/03259INMENABS.pdf","www.anthem.com/INSelectdrugtier4","17575IN0930002-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-03","Limited Cost Sharing Plan Variation",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","9"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-04","73% AV Level Silver Plan",,"0.723213791847229","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$1,000","$200","$300","$500","$2,000","$40","10"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-05","87% AV Level Silver Plan",,"0.864288926124573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$50","$100","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$0","$800","$200","$300","$400","$800","$40","11"
"2014","KS","18558","OPM","1","2013-09-25 15:48:46","1","18558","KS","Individual","No","48-0952857","18558KS0380002","Blue Cross and Blue Shield Freedom, a Multi-State Plan","18558KS038",,"KSN001","KSS001","KSF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Freedom&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0380002-06","94% AV Level Silver Plan",,"0.931155264377594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$0","$300","$200","$200","$200","$100","$40","12"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330001","Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330001-01","Standard Gold On Exchange Plan","79.10%","0.786351084709167","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$4,500","20%",,,,"$3,000","$9,000","$4,500","$13,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,500","$12","$1,152","$150","$1,272","$330","$0","$79","4"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330001","Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$79","5"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330001","Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330001","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330001-03","Limited Cost Sharing Plan Variation","79.10%","0.786351084709167","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","$13,500","$27,000","$1,500","$4,500","20%",,,,"$3,000","$9,000","$4,500","$13,500","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,500","$12","$1,152","$150","$1,272","$330","$0","$79","6"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-01","Standard Silver On Exchange Plan","71.60%","0.708419740200043","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","30%",,,,"$4,000","$12,000","$6,000","$18,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,578","$150","$1,272","$1,000","$0","$79","7"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$79","8"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-03","Limited Cost Sharing Plan Variation","71.60%","0.708419740200043","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,000","$6,000","30%",,,,"$4,000","$12,000","$6,000","$18,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,578","$150","$1,272","$1,000","$0","$79","9"
"2014","LA","97176","OPM","3","2014-01-24 09:49:15","1","97176","LA","Individual","No","23-7384555","97176LA0330002","Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan","97176LA033","7780687910","LAN001","LAS001","LAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Emergency and non-emergency coverage subject to  Blue Card Worldwide rules.","Yes","Coverage available for covered benefits","Yes","http://www.bcbsla.com/findaplan/pages/sbc.aspx?Source=SHOP&Id=97176LA0330002","https://www.bcbsla.com/marketplacepayment","www.bcbsla.com/individual-mspp-brochure","www.bcbsla.com/pharmacy-4tier-formulary","97176LA0330002-04","73% AV Level Silver Plan","73.60%","0.729070127010345","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,800","$25,600","$17,800","$27,800","$2,000","$6,000","30%",,,,"$4,000","$12,000","$6,000","$18,000","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,578","$150","$1,272","$1,000","$0","$79","10"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-01","Standard Silver On Exchange Plan","70.90%","0.712516844272614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-03","Limited Cost Sharing Plan Variation","70.90%","0.712516844272614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-04","73% AV Level Silver Plan","72.99%","0.73380970954895","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-05","87% AV Level Silver Plan","86.54%","0.8677778840065","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","1","48396","ME","Individual","No","31-1705652","48396ME0930001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930001-06","94% AV Level Silver Plan","93.40%","0.935820996761322","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0930002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF003","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930002-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0930002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF003","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0930002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME093",,"MEN002","MES001","MEF003","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0930002-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940001","Anthem Blue Cross and Blue Shield Silver Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940001-01","Standard Silver On Exchange Plan","70.97%","0.716426849365234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","ME","48396","OPM","2","2013-11-29 08:33:31","2","48396","ME","Individual","No","31-1705652","48396ME0940002","Anthem Blue Cross and Blue Shield Gold Guided Access, a Multi-State Plan","48396ME094",,"MEN001","MES002","MEF004","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0940002-03","Limited Cost Sharing Plan Variation","79.97%","0.804724991321564","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-01","Standard Silver On Exchange Plan","68.10%","0.699648082256317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$500","$850","$150","$1,400","$90","$725","$40","4"
"2014","MI","15560","OPM","2","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0410001","Blue Cross� Silver, a Multi-State Plan","15560MI041","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.943627900768567",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0410001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$40","5"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$20,000","$40,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-05","87% AV Level Silver Plan","86.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$20,000","$40,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","11"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-03","Limited Cost Sharing Plan Variation","71.31%","0.71312814950943","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","12"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-06","94% AV Level Silver Plan",,"0.931402146816254","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,"12"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","1","14002","TN","Individual","No","62-0427913","14002TN0220001","BlueCross B04P, a Multi-State Plan","14002TN022",,"TNN002","TNS001","TNF010","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0220001-01","Standard Bronze On Exchange Plan",,"0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","1","14002","TN","Individual","No","62-0427913","14002TN0220001","BlueCross B04P, a Multi-State Plan","14002TN022",,"TNN002","TNS001","TNF010","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0220001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","1","14002","TN","Individual","No","62-0427913","14002TN0220001","BlueCross B04P, a Multi-State Plan","14002TN022",,"TNN002","TNS001","TNF010","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0220001-03","Limited Cost Sharing Plan Variation",,"0.617985665798187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,300","$10,600",,,"$15,900","$31,800","$21,200","$42,400",,,,,,,,,,,,,,,,,,,,,"$5,300","$10,600","0%",,,,"$10,600","$21,200","$15,900","$31,800",,,,,,,,,"6"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-01","Standard Silver On Exchange Plan","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-05","87% AV Level Silver Plan","86.25%","0.862463176250458","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$13,500","$27,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$300","$600","20%",,,,"$7,500","$15,000","$7,800","$15,600",,,,,,,,,"8"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-06","94% AV Level Silver Plan","93.17%","0.93165785074234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$13,500","$27,000","$14,300","$28,600",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-01","Standard Silver On Exchange Plan","69.13%","0.691314995288849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-03","Limited Cost Sharing Plan Variation","68.35%","0.683525621891022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,"6"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","2","14002","TN","Individual","No","62-0427913","14002TN0230001","BlueCross S09P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230001-04","73% AV Level Silver Plan","72.01%","0.720056891441345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$13,500","$27,000","$17,150","$34,300",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$7,500","$15,000","$9,500","$19,000",,,,,,,,,"7"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF004","New","EPO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,"5"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF004","New","EPO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400001-03","Limited Cost Sharing Plan Variation",,"0.780596137046814","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","Not Applicable",,,"Not Applicable","Not Applicable","$4,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,"6"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-01","Standard Silver On Exchange Plan",,"0.682413876056671","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$2,500","Not Applicable",,,,,,,,,"7"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","Not Applicable",,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","Not Applicable","0%",,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,"8"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-03","Limited Cost Sharing Plan Variation",,"0.682413876056671","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$2,500","Not Applicable",,,,,,,,,"9"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-01","Standard Silver On Exchange Plan","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-03","Limited Cost Sharing Plan Variation","70.28%","0.702820777893066","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-04","73% AV Level Silver Plan","72.33%","0.72333550453186","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,150","$8,300",,,"$16,500","$33,000","$20,650","$41,300","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-05","87% AV Level Silver Plan","86.34%","0.863423347473145","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","$18,000","$36,000","$500","$1,000","20%",,,,"$5,000","$10,000","$5,500","$11,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","3","14002","TN","Individual","No","62-0427913","14002TN0230002","BlueCross S11P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230002-06","94% AV Level Silver Plan","93.03%","0.930253565311432","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$16,500","$33,000","$17,250","$34,500","$0","$0","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-01","Standard Silver On Exchange Plan","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-04","73% AV Level Silver Plan",,"0.724530160427094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","Not Applicable",,,"Not Applicable","Not Applicable","$5,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$1,300","Not Applicable",,,,,,,,,"10"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400002","Blue Cross Blue Shield Silver 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF001","New","EPO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400002-05","87% AV Level Silver Plan",,"0.864502251148224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,"11"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","2","31609","PA","Individual","No","23-2184623","31609PA0140002","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF002","New","PPO","Silver","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","0","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/pposilvernational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/pposilvernational","www.ibx.com/ffm/formulary2","31609PA0140002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$20,000","$40,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0030001","BlueCross Value 500.0, a Multi-State Plan","53789PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0030001-01","Standard Gold On Exchange Plan","79.50%","0.80226457118988","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","4"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0030001","BlueCross Value 500.0, a Multi-State Plan","53789PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","5"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0030001","BlueCross Value 500.0, a Multi-State Plan","53789PA003",,"PAN001","PAS001","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA003000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0030001-03","Limited Cost Sharing Plan Variation","79.50%","0.80226457118988","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","6"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0050001","BlueCross 500.0, a Multi-State Plan","53789PA005",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000102_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0050001-01","Standard Gold On Exchange Plan","79.50%","0.80226457118988","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","7"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0050001","BlueCross 500.0, a Multi-State Plan","53789PA005",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000102_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","8"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0050001","BlueCross 500.0, a Multi-State Plan","53789PA005",,"PAN002","PAS002","PAF001","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA005000102_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0050001-03","Limited Cost Sharing Plan Variation","79.50%","0.80226457118988","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$0","$200","$800","$2,000","$0","$80","9"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-01","Standard Silver On Exchange Plan","71.31%","0.71312814950943","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","10"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140002","my Blue Cross $2000, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0",,"$0","$0","$0",,"11"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140002","my Blue Cross $2000, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140002-03","Limited Cost Sharing Plan Variation","78.20%","0.806536376476288","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$100","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$10","$150","$2,000","$0","$0","$150","12"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MT","30751","OPM","3","2013-10-17 08:32:07","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-01","Standard Silver On Exchange Plan","70.55%","0.709414541721344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-03","Limited Cost Sharing Plan Variation","70.55%","0.709414541721344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-04","73% AV Level Silver Plan","72.61%","0.729691684246063","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-05","87% AV Level Silver Plan","86.03%","0.861178755760193","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","1","96751","NH","Individual","No","02-0494919","96751NH0330001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","96751NH033",,"NHN001","NHS001","NHF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330001-06","94% AV Level Silver Plan","93.03%","0.930774927139282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","2","96751","NH","Individual","No","02-0494919","96751NH0330002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN002","NHS001","NHF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330002-01","Standard Gold On Exchange Plan","79.82%","0.805286765098572","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","2","96751","NH","Individual","No","02-0494919","96751NH0330002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN002","NHS001","NHF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NH","96751","OPM","3","2014-03-19 13:58:38","2","96751","NH","Individual","No","02-0494919","96751NH0330002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","96751NH033",,"NHN002","NHS001","NHF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0330002-03","Limited Cost Sharing Plan Variation","79.82%","0.805286765098572","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350002","BCBS Premier 2, MSP 500/4,000","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350002","BCBS Premier 2, MSP 500/4,000","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350003","BCBS Solution 3, MSP 4,500/6,350","75605NM035",,"NMN001","NMS001","NMF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","1","75605","NM","Individual","No","36-1236610","75605NM0350004","BCBS Solution 4, MSP 6,250/6,250","75605NM035",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-06","94% AV Level Silver Plan","94.14%","0.931707143783569","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","8%","$0","$0","8%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$40","$0","$80","21"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-01","Standard Silver On Exchange Plan","70.70%","0.693464457988739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$500","$0","$150","$2,500","$0","$0","$150","4"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0",,"$0","$0","$0",,"5"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-03","Limited Cost Sharing Plan Variation","70.70%","0.693464457988739","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$500","$0","$150","$2,500","$0","$0","$150","6"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-04","73% AV Level Silver Plan","72.70%","0.739089787006378","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,800","$3,600","0%",,,,"$3,600","$7,200","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$0","$0",,"$1,800","$0","$0",,"7"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-05","87% AV Level Silver Plan","86.50%","0.87455028295517","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$1,500","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$0",,"$1,500","$0","$0",,"8"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140001","my Blue Cross $2500, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700067000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140001-06","94% AV Level Silver Plan","94.80%","0.940883457660675","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,200","$2,400","Not Applicable","Not Applicable","$100","$200","0%",,,,"$200","$400","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$0",,"$100","$0","$0",,"9"
"2014","PA","55957","OPM","3","2013-11-27 09:24:34","1","55957","PA","Individual","No","23-2905083","55957PA0140002","my Blue Cross $2000, a Multi-State Plan","55957PA014",,"PAN001","PAS001","PAF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCare Worldwide","Yes","BlueCard PPO","Yes","https://api.bcnepa.com/sbc/download.pdf?group=700070000&effectivedate=2014-01-01",,,"www.bcnepa.com","55957PA0140002-01","Standard Gold On Exchange Plan","78.20%","0.806536376476288","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$100","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$100","$10","$150","$2,000","$0","$0","$150","10"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-03","Limited Cost Sharing Plan Variation","68.95%","0.689522922039032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"6"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-04","73% AV Level Silver Plan","72.07%","0.720732450485229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","$21,500","$43,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$8,000","$16,000","$11,000","$22,000",,,,,,,,,"7"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-05","87% AV Level Silver Plan","86.05%","0.860458195209503","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$16,500","$33,000","$18,500","$37,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$8,000","$16,000","$8,750","$17,500",,,,,,,,,"8"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","2","75605","NM","Individual","No","36-1236610","75605NM0350005","BCBS Basic 5, MSP 3,750/6,250","75605NM035",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","2","75605","NM","Individual","No","36-1236610","75605NM0350005","BCBS Basic 5, MSP 3,750/6,250","75605NM035",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NM","75605","OPM","3","2013-11-29 08:33:31","2","75605","NM","Individual","No","36-1236610","75605NM0350005","BCBS Basic 5, MSP 3,750/6,250","75605NM035",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0350005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,500",,,"$4,000","$9,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","1","87571","OK","Individual","No","36-1236610","87571OK0310004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","2","87571","OK","Individual","No","36-1236610","87571OK0310005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","2","87571","OK","Individual","No","36-1236610","87571OK0310005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OK","87571","OPM","2","2013-10-16 19:58:29","2","87571","OK","Individual","No","36-1236610","87571OK0310005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","87571OK031",,"OKN001","OKS001","OKF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsok.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/OK/exchange_referred","http://www.bcbsok.com/coverage/individual/on-exchange/","www.bcbsok.com/member/prescriptiondrugs.html","87571OK0310005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogoldnational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/ppogoldnational","www.ibx.com/ffm/formulary2","31609PA0140001-01","Standard Gold On Exchange Plan","81.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","PA","31609","OPM","3","2014-01-24 09:49:15","1","31609","PA","Individual","No","23-2184623","31609PA0140001","Blue Cross, a Multi-State Plan","31609PA014",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","Yes","No",,"Acupuncture, Bariatric Surgery, Cosmetic Surgery, Dental Care (Adult), Hearing Aids, Infertility Treatment, Long-term Care, Private Duty Nursing, Routine eye care (Adult), Routine foot care, Weight Loss programs","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9994",,"$200","5","0","0","2014-01-01",,"Yes","Coverage is provided for benefits received while outside of the U.S.","Yes","Coverage is provided for benefits received anywhere in the U.S","Yes","www.ibx4you.com/ffm/ppogoldnational","apply.ibx4you.com/ibc/payment/PaymentPortalStart.action","www.ibx4you.com/ffm/ppogoldnational","www.ibx.com/ffm/formulary2","31609PA0140001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-04","73% AV Level Silver Plan","73.79%","0.737896263599396","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","49%","$0","$0","49%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","13"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-05","87% AV Level Silver Plan","86.98%","0.869839251041412","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%","$0","$0","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$100","$0","$80","14"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0040001","BlueCross Value 0.50,  a Multi-State Plan","53789PA004",,"PAN001","PAS001","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA004000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0040001-06","94% AV Level Silver Plan","94.14%","0.931707143783569","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","8%","$0","$0","8%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$40","$0","$80","15"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-01","Standard Silver On Exchange Plan","71.31%","0.71312814950943","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","16"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$80","17"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-03","Limited Cost Sharing Plan Variation","71.31%","0.71312814950943","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%","$0","$0","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","18"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-04","73% AV Level Silver Plan","73.79%","0.737896263599396","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","49%","$0","$0","49%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$200","$0","$80","19"
"2014","PA","53789","OPM","2","2013-10-17 08:32:07","1","53789","PA","Individual","No","23-2399845","53789PA0060001","BlueCross 0.50, a Multi-State Plan","53789PA006",,"PAN002","PAS002","PAF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","all except OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergent & Urgent","Yes","Emergent & Urgent","Yes","www.capbluecross.com/pdf/benefits_summary/ia/53789PA006000101_2014.pdf","https://w2.capbluecross.com/sp/ACS.saml2",,"https://www.capbluecross.com/wps/wcm/connect/cbc-public/cbc/members/drugformularyinformation_forms","53789PA0060001-05","87% AV Level Silver Plan","86.98%","0.869839251041412","Yes","Yes","Yes","50%","50%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","25%","$0","$0","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$100","$0","$80","20"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, A Multi-State Plan","40308VA022",,"VAN002","VAS001","VAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996570417081536",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPPVBN7ARXMVBN7AN012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0220001-03","Limited Cost Sharing Plan Variation","78.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$0","$940","$150","$500","$300","$750","$80","6"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,110","$150","$1,500","$150","$770","$80","7"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-03","Limited Cost Sharing Plan Variation","68.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,110","$150","$1,500","$150","$770","$80","9"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-04","73% AV Level Silver Plan","73.66%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$17,700","$35,400",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-05","87% AV Level Silver Plan","87.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0280001","BlueCross BlueShield Preferred 1500, A Multi-State Plan","40308VA028",,"VAN002","VAS001","VAF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996567986552111",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPHVBN6ARXMVBN60N012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0280001-06","94% AV Level Silver Plan","93.22%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$14,750","$29,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","12"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-01","Standard Silver On Exchange Plan","71.37%","0.71509200334549","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Bronze 1","62141AR008",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080005-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Bronze 1","62141AR008",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080005","Ambetter Bronze 1","62141AR008",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080005-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0050004","Pediatric Gold Plan","28348AR005",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.63",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0050004-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010004","BEST Dental Plus - Gold","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Plus_Plan_(Gold).pdf",,"26904AR0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020004","BESTOne Dental Plus - Gold","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"26904AR0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010004","BEST Dental Plus - Gold","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Plus_Plan_(Gold).pdf",,"26904AR0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020004","BESTOne Dental Plus - Gold","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"26904AR0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020005","BESTOne Dental Plus - Silver","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"26904AR0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010005","BEST Dental Plus - Silver","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Plus_Plan_(Silver).pdf",,"26904AR0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010005","BEST Dental Plus - Silver","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Plus_Plan_(Silver).pdf",,"26904AR0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020005","BESTOne Dental Plus - Silver","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"26904AR0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010006","BEST Dental Basic - Silver","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Basic_Plan_(Silver).pdf",,"26904AR0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020006","BESTOne Dental Basic - Silver","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"26904AR0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Gold 2","62141AR008",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080002-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Gold 2","62141AR008",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080002","Ambetter Gold 2","62141AR008",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080002-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"$8,000","$24,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010001","BEST Life Child Dental Plus","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Child_Dental_Plus_Plan.pdf",,"26904AR0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020002","BESTOne Child Dental","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Child_Dental_Plan.pdf",,"26904AR0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010002","BEST Life Child Dental","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Child_Dental_Plan.pdf",,"26904AR0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020002","BESTOne Child Dental","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Child_Dental_Plan.pdf",,"26904AR0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010002","BEST Life Child Dental","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Child_Dental_Plan.pdf",,"26904AR0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020003","BESTOne Dental Advantage - Gold","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"26904AR0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$12,700","20%",,,,"$9,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010006","BEST Dental Basic - Silver","26904AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Basic_Plan_(Silver).pdf",,"26904AR0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020006","BESTOne Dental Basic - Silver","26904AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"26904AR0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0050001","Pediatric Silver Plan","28348AR005",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$21.55",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0060004","Pediatric Gold Plan","28348AR006",,"ARN002","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.42",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0060004-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-03","Limited Cost Sharing Plan Variation","69.13%","0.691314995288849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-04","73% AV Level Silver Plan","72.26%","0.722588956356049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-05","87% AV Level Silver Plan","87.49%","0.874894440174103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400","Not Applicable","Not Applicable","$650","$1,300","10%",,,,"$6,400","$12,800","$7,050","$14,100","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130001","Blue Cross Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130001-06","94% AV Level Silver Plan","94.14%","0.941447615623474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$6,400","$12,800","$6,500","$13,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-01","Standard Silver On Exchange Plan","69.13%","0.691314995288849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-03","Limited Cost Sharing Plan Variation","69.13%","0.691314995288849","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-04","73% AV Level Silver Plan","72.26%","0.722588956356049","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,200","$6,400","20%",,,,"$6,400","$12,800","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-05","87% AV Level Silver Plan","87.49%","0.874894440174103","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$12,700","$25,400","Not Applicable","Not Applicable","$650","$1,300","10%",,,,"$6,400","$12,800","$7,050","$14,100","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130003","Blue Shield Shared Cost 3200, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9981",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130003-06","94% AV Level Silver Plan","94.14%","0.941447615623474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$6,400","$12,800","$6,500","$13,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130004-01","Standard Gold On Exchange Plan","78.38%","0.783825159072876","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130004","Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN001","PAS001","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130004-03","Limited Cost Sharing Plan Variation","78.38%","0.783825159072876","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130002-01","Standard Gold On Exchange Plan","78.38%","0.783825159072876","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"19"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","PA","70194","OPM","3","2014-03-21 10:00:27","1","70194","PA","Individual","No","54-1637426","70194PA0130002","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","70194PA013",,"PAN002","PAS002","PAF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9984",,,"0","0","0","2014-01-01",,"Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","Members pay coinsurance after satisfying network deductible. If a member receives non-emergency care from a non-Blue Card provider, services will be covered at the lower, out-of-network level.","Yes","https://www.highmark.com/sbc/bcbs.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","70194PA0130002-03","Limited Cost Sharing Plan Variation","78.38%","0.783825159072876","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","SC","26065","OPM","2","2014-01-24 09:49:15","1","26065","SC","Individual","No","57-0287419","26065SC0400001","Blue Cross Blue Shield Gold 1, a Multi-State Plan","26065SC040",,"SCN001","SCS001","SCF004","New","EPO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard","Yes","https://www.southcarolinablues.com/links/metallic/SBC","https://www.southcarolinablues.com/links/metallic/pay","www.southcarolinablues.com/links/metallic/mspp","https://www.southcarolinablues.com/links/metallic/pharmacy","26065SC0400001-01","Standard Gold On Exchange Plan",,"0.780596137046814","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,200","Not Applicable",,,"Not Applicable","Not Applicable","$4,200","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","4","14002","TN","Individual","No","62-0427913","14002TN0230003","BlueCross S12P, a Multi-State Plan","14002TN023",,"TNN002","TNS001","TNF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0230003-06","94% AV Level Silver Plan","93.01%","0.930114090442657","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$16,500","$33,000","$17,600","$35,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","5","14002","TN","Individual","No","62-0427913","14002TN0300001","BlueCross G08P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF010","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300001-01","Standard Gold On Exchange Plan",,"0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","5","14002","TN","Individual","No","62-0427913","14002TN0300001","BlueCross G08P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF010","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","5","14002","TN","Individual","No","62-0427913","14002TN0300001","BlueCross G08P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF010","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300001-03","Limited Cost Sharing Plan Variation",,"0.780541837215424","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$6,300","$12,600","$8,400","$16,800",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600",,,,,,,,,"6"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","6","14002","TN","Individual","No","62-0427913","14002TN0300002","BlueCross G11P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300002-01","Standard Gold On Exchange Plan","79.68%","0.796816945075989","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","6","14002","TN","Individual","No","62-0427913","14002TN0300002","BlueCross G11P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","TN","14002","OPM","2","2014-02-12 13:51:41","6","14002","TN","Individual","No","62-0427913","14002TN0300002","BlueCross G11P, a Multi-State Plan","14002TN030",,"TNN002","TNS001","TNF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard Worldwide","Yes","BlueCard PPO","Yes","http://www.bcbst.com/sbc","https://bcbst.healthinsurance-asp.com/bcbst/payment/PaymentPortalStart.action","www.bcbst.com/brochures","http://www.bcbst.com/pharmacy/","14002TN0300002-03","Limited Cost Sharing Plan Variation","79.68%","0.796816945075989","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000","$3,500","$7,000","0%",,,,"$7,000","$14,000","$10,500","$21,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$8,250",,,"$5,500","$16,500","Not Applicable","Not Applicable","$1,000","$3,000","20%",,,,"$2,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-01","Standard Silver On Exchange Plan","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-03","Limited Cost Sharing Plan Variation","71.20%","0.717493534088135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-04","73% AV Level Silver Plan","73.39%","0.738157749176025","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-05","87% AV Level Silver Plan","86.13%","0.862549245357513","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","1","79475","WI","Individual","No","39-1462554","79475WI0500001","Anthem Blue Cross and Blue Shield Silver DirectAccess, a Multi-State Plan","79475WI050",,"WIN001","WIS001","WIF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500001-06","94% AV Level Silver Plan","93.08%","0.931559145450592","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","2","79475","WI","Individual","No","39-1462554","79475WI0500002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN002","WIS001","WIF001","New","POS","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500002-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","2","79475","WI","Individual","No","39-1462554","79475WI0500002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN002","WIS001","WIF001","New","POS","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0290001","BlueCross BlueShield Preferred 2000, A Multi-State Plan","40308VA029",,"VAN002","VAS001","VAF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996826577452055",,,"0","0","0","2014-01-01",,"Yes","All covered services","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BPHVB06CRXMVB06CN012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0290001-01","Standard Silver On Exchange Plan","70.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$20","$1,010","$150","$2,000","$290","$260","$80","4"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0230001","BlueCross BlueShield Preferred 1000, A Multi-State Plan","40308VA023",,"VAN002","VAS001","VAF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996826577452055",,,"0","0","0","2014-01-01",,"Yes","All covered services","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BPHVB07BRXMVB07AN012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0230001-01","Standard Gold On Exchange Plan","79.88%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$2,000","$4,000","$3,000","$6,000","$1,000","$20","$510","$150","$1,000","$360","$180","$80","5"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, A Multi-State Plan","40308VA022",,"VAN002","VAS001","VAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996570417081536",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPPVBN7ARXMVBN7AN012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0220001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0010004","Pediatric Gold Plan","28348AR001",,"ARN001","ARS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.92",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=PedGoldSched","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","https://www.deltadentalar.com/dd/Exchange.aspx?DView=PedGoldPlan",,"28348AR0010004-01","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0070004","Pediatric Gold Plan","28348AR007",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.71",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,,,,"28348AR0070004-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","2","28348","AR","Individual","Yes","71-0561140","28348AR0050003","Pediatric Silver Plan","28348AR005",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.98",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0050003-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090006","Ambetter Bronze 2 + Vision","62141AR009",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090006","Ambetter Bronze 2 + Vision","62141AR009",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090006-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","15"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-01","Standard Silver On Exchange Plan","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-03","Limited Cost Sharing Plan Variation","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-04","73% AV Level Silver Plan","73.96%","0.739648163318634","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500","20%",,,,"$4,000","$8,000","$6,000","$12,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,770","$1,320","$0","$150","$2,000","$610","$110","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-05","87% AV Level Silver Plan","87.99%","0.879927635192871","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$250","$500","10%",,,,"$4,000","$8,000","$6,000","$12,000","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$410","$0","$150","$300","$590","$100","$80","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090003","Ambetter Silver 1 + Vision","62141AR009",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090003-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","9"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-01","Standard Silver On Exchange Plan","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-03","Limited Cost Sharing Plan Variation","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-04","73% AV Level Silver Plan","73.88%","0.738831877708435","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000","10%",,,,"$6,000","$12,000","$7,500","$15,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$1,120","$0","$150","$2,670","$390","$0","$80","13"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF001","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable","$6,250","$12,700","0%",,,,"$12,500","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","1","33602","TX","Individual","No","36-1236610","33602TX0440004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF003","New","PPO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","2","33602","TX","Individual","No","36-1236610","33602TX0440005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","2","33602","TX","Individual","No","36-1236610","33602TX0440005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","TX","33602","OPM","3","2013-11-27 09:24:34","2","33602","TX","Individual","No","36-1236610","33602TX0440005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","33602TX044",,"TXN001","TXS001","TXF002","New","PPO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbstx.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/TX/exchange_referred","http://www.bcbstx.com/coverage/individual/on-exchange/","www.bcbstx.com/member/rx_drugs.html","33602TX0440005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$11,250","30%",,,,"$7,500","$22,500","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","40308","OPM","5","2014-01-24 09:49:15","1","40308","VA","Individual","No","53-0078070","40308VA0220001","BlueCross BlueShield Preferred 500, A Multi-State Plan","40308VA022",,"VAN002","VAS001","VAF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996570417081536",,,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes","http://content.carefirst.com/sbc/BPPVBN7ARXMVBN7AN012014.pdf",,,"http://www.carefirst.com/acarx","40308VA0220001-01","Standard Gold On Exchange Plan","78.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$7,500","$15,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,000","$2,000","$1,500","$3,000","$500","$0","$940","$150","$500","$300","$750","$80","4"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-03","Limited Cost Sharing Plan Variation","71.37%","0.71509200334549","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-04","73% AV Level Silver Plan","73.75%","0.739178836345673","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-05","87% AV Level Silver Plan","86.09%","0.86168760061264","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","30%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","1","88380","VA","Individual","No","54-1356687","88380VA0880001","Anthem Blue Cross and Blue Shield HealthKeepers Silver DirectAccess, a Multi-State Plan","88380VA088",,"VAN001","VAS001","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880001-06","94% AV Level Silver Plan","93.02%","0.93088173866272","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","30%","$200","$400","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","2","88380","VA","Individual","No","54-1356687","88380VA0880002","Anthem Blue Cross and Blue Shield HealthKeepers Gold DirectAccess, a Multi-State Plan","88380VA088",,"VAN002","VAS001","VAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880002-01","Standard Gold On Exchange Plan","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","2","88380","VA","Individual","No","54-1356687","88380VA0880002","Anthem Blue Cross and Blue Shield HealthKeepers Gold DirectAccess, a Multi-State Plan","88380VA088",,"VAN002","VAS001","VAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","OPM","4","2014-03-19 13:58:38","2","88380","VA","Individual","No","54-1356687","88380VA0880002","Anthem Blue Cross and Blue Shield HealthKeepers Gold DirectAccess, a Multi-State Plan","88380VA088",,"VAN002","VAS001","VAF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0880002-03","Limited Cost Sharing Plan Variation","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WI","79475","OPM","2","2013-11-27 09:24:34","2","79475","WI","Individual","No","39-1462554","79475WI0500002","Anthem Blue Cross and Blue Shield Gold DirectAccess, a Multi-State Plan","79475WI050",,"WIN002","WIS001","WIF001","New","POS","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/wi","http://file.anthem.com/03262WIMENABS.pdf","www.anthem.com/WISelectdrugtier4","79475WI0500002-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-01","Standard Silver On Exchange Plan",,"0.699418485164642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-03","Limited Cost Sharing Plan Variation",,"0.699418485164642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-04","73% AV Level Silver Plan",,"0.722863674163818","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800","$4,000","$8,000","20%",,,,"$9,500","$19,000","$13,500","$27,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-05","87% AV Level Silver Plan",,"0.87159663438797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","$14,200","$28,400","$500","$1,000","10%",,,,"$9,500","$19,000","$10,000","$20,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-06","94% AV Level Silver Plan",,"0.938876569271088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","$13,200","$26,400","$100","$200","10%",,,,"$9,500","$19,000","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-01","Standard Gold On Exchange Plan",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","WV","31274","OPM","5","2014-03-21 10:00:27","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.HighmarkBCBSWV.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-03","Limited Cost Sharing Plan Variation",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020001","BESTOne Child Dental Plus","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Child_Dental_Plus_Plan.pdf",,"26904AR0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010001","BEST Life Child Dental Plus","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Child_Dental_Plus_Plan.pdf",,"26904AR0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020001","BESTOne Child Dental Plus","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Child_Dental_Plus_Plan.pdf",,"26904AR0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010003","BEST Dental Advantage - Gold","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Advantage_Plan_(Gold).pdf",,"26904AR0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","SHOP (Small Group)","Yes","95-6042390","26904AR0010003","BEST Dental Advantage - Gold","26904AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BEST_Dental_Advantage_Plan_(Gold).pdf",,"26904AR0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","26904","SERFF","6","2014-01-22 11:51:12","1","26904","AR","Individual","Yes","95-6042390","26904AR0020003","BESTOne Dental Advantage - Gold","26904AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/AR/pdf/AR_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"26904AR0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","2","28348","AR","Individual","Yes","71-0561140","28348AR0030004","Family Gold Plan","28348AR003",,"ARN001","ARS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.92",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=FamGoldSched","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","https://www.deltadentalar.com/dd/Exchange.aspx?DView=FamGoldPlan",,"28348AR0030004-01","Standard High On Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","2","28348","AR","Individual","Yes","71-0561140","28348AR0080004","Family Gold Plan","28348AR008",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.71",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,,,,"28348AR0080004-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","1","28348","AR","Individual","Yes","71-0561140","28348AR0060001","Pediatric Silver Plan","28348AR006",,"ARN002","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.20",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080001","Ambetter Gold 1","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080001-01","Standard Gold On Exchange Plan",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080001","Ambetter Gold 1","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080001","Ambetter Gold 1","62141AR008",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080001-03","Limited Cost Sharing Plan Variation",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$6,000","$12,000","$450","$900","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","15"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090001","Ambetter Gold 1 + Vision","62141AR009",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090001-01","Standard Gold On Exchange Plan",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090001","Ambetter Gold 1 + Vision","62141AR009",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090001","Ambetter Gold 1 + Vision","62141AR009",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090001-03","Limited Cost Sharing Plan Variation",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090002","Ambetter Gold 2 + Vision","62141AR009",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090002-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090002","Ambetter Gold 2 + Vision","62141AR009",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090002","Ambetter Gold 2 + Vision","62141AR009",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090002-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090005","Ambetter Bronze 1 + Vision","62141AR009",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090005-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090005","Ambetter Bronze 1 + Vision","62141AR009",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090005","Ambetter Bronze 1 + Vision","62141AR009",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090005-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","3","62141","AR","Individual","No","06-0641618","62141AR0090006","Ambetter Bronze 2 + Vision","62141AR009",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090006-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","13"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-05","87% AV Level Silver Plan","87.70%","0.877011597156525","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$500","$1,000","5%",,,,"$6,000","$12,000","$1,500","$3,000","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$50","$80","14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","4","62141","AR","Individual","No","06-0641618","62141AR0090004","Ambetter Silver 2 + Vision","62141AR009",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.98414760779421",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0090004-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$6,000","$12,000","$450","$900","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","15"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100001","Ambetter Gold 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100001-01","Standard Gold On Exchange Plan",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100001","Ambetter Gold 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100001","Ambetter Gold 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100001-03","Limited Cost Sharing Plan Variation",,"0.780103087425232","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,500","$3,000","10%",,,,"$3,000","$6,000","$4,500","$9,000","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$0","$580","$150","$2,500","$270","$90","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100002","Ambetter Gold 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100002-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100002","Ambetter Gold 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100002","Ambetter Gold 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100002-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Bronze 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100005-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Bronze 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100005","Ambetter Bronze 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF009","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100005-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100006","Ambetter Bronze 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100006-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","13"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","2","28348","AR","Individual","Yes","71-0561140","28348AR0060003","Pediatric Silver Plan","28348AR006",,"ARN002","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.67",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/delta","https://www.deltadentalar.com/dd/Exchange.aspx?DView=Marketplace",,"28348AR0060003-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","3","28348","AR","Individual","Yes","71-0561140","28348AR0010003","Pediatric Silver Plan","28348AR001",,"ARN001","ARS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=PedSilverSched","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","https://www.deltadentalar.com/dd/Exchange.aspx?DView=PedSilverPlan",,"28348AR0010003-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","3","28348","AR","Individual","Yes","71-0561140","28348AR0070003","Pediatric Silver Plan","28348AR007",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.05",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,,,,"28348AR0070003-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080006","Ambetter Bronze 2","62141AR008",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080006-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","13"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080006","Ambetter Bronze 2","62141AR008",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","1","62141","AR","Individual","No","06-0641618","62141AR0080006","Ambetter Bronze 2","62141AR008",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080006-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","15"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-01","Standard Silver On Exchange Plan","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-03","Limited Cost Sharing Plan Variation","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-04","73% AV Level Silver Plan","73.96%","0.739648163318634","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500","20%",,,,"$4,000","$8,000","$6,000","$12,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,770","$1,320","$0","$150","$2,000","$610","$110","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-05","87% AV Level Silver Plan","87.99%","0.879927635192871","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$250","$500","10%",,,,"$4,000","$8,000","$6,000","$12,000","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$410","$0","$150","$300","$590","$100","$80","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080003","Ambetter Silver 1","62141AR008",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080003-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","9"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-01","Standard Silver On Exchange Plan","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-03","Limited Cost Sharing Plan Variation","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-04","73% AV Level Silver Plan","73.88%","0.738831877708435","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000","10%",,,,"$6,000","$12,000","$7,500","$15,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$1,120","$0","$150","$2,670","$390","$0","$80","13"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","2","62141","AR","Individual","No","06-0641618","62141AR0080004","Ambetter Silver 2","62141AR008",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0080004-05","87% AV Level Silver Plan","87.70%","0.877011597156525","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$500","$1,000","5%",,,,"$6,000","$12,000","$1,500","$3,000","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$50","$80","14"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","4","28348","AR","Individual","Yes","71-0561140","28348AR0030003","Family Silver Plan","28348AR003",,"ARN001","ARS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.10",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes","https://www.deltadentalar.com/dd/Exchange.aspx?DView=FamSilverSched","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/28348","https://www.deltadentalar.com/dd/Exchange.aspx?DView=FamSilverPlan",,"28348AR0030003-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","28348","SERFF","5","2013-11-27 09:24:34","4","28348","AR","Individual","Yes","71-0561140","28348AR0080003","Family Silver Plan","28348AR008",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.05",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Claims will be paid as a out of network in US dollars using an approved fee level based on the policy holders home address","Yes","Claims will be paid based on In Network fee level and out of network benefit levels.","Yes",,,,,"28348AR0080003-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","30%","70%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$50",,"$50","$50",,"$50","$50","$50","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","1","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0010001","Guardian Pediatric Advantage","31227AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","1","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0010001","Guardian Pediatric Advantage","31227AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0010001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","1","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0020001","Guardian Pediatric Essentials","31227AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0020001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","1","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0020001","Guardian Pediatric Essentials","31227AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0020001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","2","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0030001","Guardian Family Advantage Plus","31227AR003",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0030001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","2","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0030001","Guardian Family Advantage Plus","31227AR003",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0030001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","3","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0050001","Guardian Family Essentials Plus","31227AR005",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0050001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","3","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0050001","Guardian Family Essentials Plus","31227AR005",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0050001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","4","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0040001","Guardian Family Advantage","31227AR004",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0040001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","4","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0040001","Guardian Family Advantage","31227AR004",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.20",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0040001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","4","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0060001","Guardian Family Essentials","31227AR006",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0060001-00","Standard Low Off Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","31227","SERFF","3","2013-09-17 21:55:00","4","31227","AR","SHOP (Small Group)","Yes","13-5123390","31227AR0060001","Guardian Family Essentials","31227AR006",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"31227AR0060001-01","Standard Low On Exchange Plan","68.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","48168","SERFF","1","2013-08-05 08:16:03","1","48168","AR","SHOP (Small Group)","Yes","47-0098400","48168AR0040002","EHB High PPO","48168AR004",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.16",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48168AR0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070007","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070007-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","14"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070007","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070007-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","15"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070007","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","16"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070007","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070007-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","17"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070008","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070008-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","18"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070008","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070008-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","19"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070008","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","20"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070008","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS002","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070008-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","21"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070012","Catastrophic Plus","70525AR007",,"ARN001","ARS002","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070012-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","22"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070012","Catastrophic Plus","70525AR007",,"ARN001","ARS002","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070012-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","23"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070013","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070013-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","24"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070013","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070013-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","25"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070024","Catastrophic Plus","70525AR007",,"ARN001","ARS004","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070024-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","42"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070024","Catastrophic Plus","70525AR007",,"ARN001","ARS004","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070024-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","43"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070025","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070025-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","44"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070025","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070025-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","45"
"2014","AR","48168","SERFF","1","2013-08-05 08:16:03","1","48168","AR","SHOP (Small Group)","Yes","47-0098400","48168AR0040001","EHB Low PPO","48168AR004",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.88",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48168AR0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","48168","SERFF","1","2013-08-05 08:16:03","1","48168","AR","SHOP (Small Group)","Yes","47-0098400","48168AR0030002","EHB High Passive","48168AR003",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.36",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48168AR0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","48168","SERFF","1","2013-08-05 08:16:03","1","48168","AR","SHOP (Small Group)","Yes","47-0098400","48168AR0030001","EHB Low Passive","48168AR003",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.44",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48168AR0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","53741","SERFF","3","2013-08-23 12:24:02","1","53741","AR","SHOP (Small Group)","Yes","93-0242990","53741AR0040002","EHB High PPO","53741AR004",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"53741AR0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","53741","SERFF","3","2013-08-23 12:24:02","1","53741","AR","SHOP (Small Group)","Yes","93-0242990","53741AR0040001","EHB Low PPO","53741AR004",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.16",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"53741AR0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","53741","SERFF","3","2013-08-23 12:24:02","1","53741","AR","SHOP (Small Group)","Yes","93-0242990","53741AR0030002","EHB High Passive","53741AR003",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.84",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"53741AR0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","53741","SERFF","3","2013-08-23 12:24:02","1","53741","AR","SHOP (Small Group)","Yes","93-0242990","53741AR0030001","EHB Low Passive","53741AR003",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.76",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"53741AR0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","Individual","Yes","75-1233841","60559AR0010001","Dentegra Dental PPO Children's Plan 70","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010001",,"60559AR0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020001",,"60559AR0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020001",,"60559AR0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","Individual","Yes","75-1233841","60559AR0010001","Dentegra Dental PPO Children's Plan 70","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010001",,"60559AR0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020002",,"60559AR0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","Individual","Yes","75-1233841","60559AR0010002","Dentegra Dental PPO Children's Plan 85","60559AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.50",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010002",,"60559AR0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","Individual","Yes","75-1233841","60559AR0010002","Dentegra Dental PPO Children's Plan 85","60559AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.50",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010002",,"60559AR0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","1","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020002",,"60559AR0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","2","60559","AR","Individual","Yes","75-1233841","60559AR0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010006",,"60559AR0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","2","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020006",,"60559AR0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","2","60559","AR","Individual","Yes","75-1233841","60559AR0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","60559AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010006",,"60559AR0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","2","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.38",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020006",,"60559AR0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","3","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020004",,"60559AR0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","3","60559","AR","Individual","Yes","75-1233841","60559AR0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","60559AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010004",,"60559AR0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","3","60559","AR","Individual","Yes","75-1233841","60559AR0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","60559AR001",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.87",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/ar/60559ar0010004",,"60559AR0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","60559","SERFF","10","2014-01-23 12:49:01","3","60559","AR","SHOP (Small Group)","Yes","75-1233841","60559AR0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","60559AR002",,"ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.73",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/ar/60559ar0020004",,"60559AR0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100006","Ambetter Bronze 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","5","62141","AR","Individual","No","06-0641618","62141AR0100006","Ambetter Bronze 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF011","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100006-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","15"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-01","Standard Silver On Exchange Plan","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","4"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-03","Limited Cost Sharing Plan Variation","68.26%","0.682594239711761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,020","$1,430","$0","$150","$2,500","$730","$100","$80","6"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-04","73% AV Level Silver Plan","73.96%","0.739648163318634","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$1,750","$3,500","20%",,,,"$4,000","$8,000","$6,000","$12,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,770","$1,320","$0","$150","$2,000","$610","$110","$80","7"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-05","87% AV Level Silver Plan","87.99%","0.879927635192871","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$250","$500","10%",,,,"$4,000","$8,000","$6,000","$12,000","$50","$100","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$270","$410","$0","$150","$300","$590","$100","$80","8"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100003","Ambetter Silver 1 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100003-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","9"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-01","Standard Silver On Exchange Plan","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","10"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-03","Limited Cost Sharing Plan Variation","68.49%","0.684876263141632","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","$18,850","$37,700","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","12"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-04","73% AV Level Silver Plan","73.88%","0.738831877708435","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,500","$25,000","$18,850","$37,700","$2,500","$5,000","10%",,,,"$6,000","$12,000","$7,500","$15,000","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$1,120","$0","$150","$2,670","$390","$0","$80","13"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-05","87% AV Level Silver Plan","87.70%","0.877011597156525","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,500","$25,000","$18,850","$37,700","$500","$1,000","5%",,,,"$6,000","$12,000","$1,500","$3,000","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$50","$80","14"
"2014","AR","62141","SERFF","7","2014-01-22 11:51:12","6","62141","AR","Individual","No","06-0641618","62141AR0100004","Ambetter Silver 2 + Vision + Adult Dental","62141AR010",,"ARN001","ARS001","ARF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.935020267285745",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.ambetterofarkansas.com/benefits","http://ambetter.ambetterofarkansas.com/payments","http://ambetter.ambetterofarkansas.com/ourplans","http://ambetter.ambetterofarkansas.com/formulary","62141AR0100004-06","94% AV Level Silver Plan","94.78%","0.950640082359314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,500","$25,000","$18,850","$37,700","$150","$300","0%",,,,"$6,000","$12,000","$450","$900","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$160","$0","$150","$150","$240","$0","$80","15"
"2014","AR","67635","SERFF","2","2013-09-02 14:52:56","1","67635","AR","SHOP (Small Group)","Yes","35-0472300","67635AR0010001","DentalConnect�","67635AR001",,"ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"67635AR0010001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","67635","SERFF","2","2013-09-02 14:52:56","1","67635","AR","SHOP (Small Group)","Yes","35-0472300","67635AR0010002","DentalConnect�","67635AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"67635AR0010002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","67635","SERFF","2","2013-09-02 14:52:56","2","67635","AR","SHOP (Small Group)","Yes","35-0472300","67635AR0010003","DentalConnect�","67635AR001",,"ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"67635AR0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070001-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","4"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070001-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","5"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","6"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070001","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070001-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","7"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070002-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","8"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070002-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","9"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","10"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070002","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070002-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","11"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070006","Catastrophic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070006-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","12"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070006","Catastrophic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070006-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","13"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070013","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","26"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070013","Bronze Basic Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070013-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","27"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070014","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070014-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","28"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070014","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070014-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","29"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070014","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","30"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070014","Bronze Premier Saver Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070014-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","31"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070018","Catastrophic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","32"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070018","Catastrophic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","33"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070019","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070019-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","34"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070019","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070019-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","35"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070019","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","36"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070019","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070019-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","37"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070020","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070020-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","38"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070020","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070020-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","39"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070020","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070020-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","40"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070020","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS004","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070020-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","41"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070025","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","46"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070025","Bronze Basic Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070025-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","47"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070026","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070026-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","48"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070026","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070026-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","49"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070026","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","50"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070026","Bronze Premier Saver Plus","70525AR007",,"ARN001","ARS007","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070026-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","51"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070030","Catastrophic Plus","70525AR007",,"ARN001","ARS007","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070030-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","52"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070030","Catastrophic Plus","70525AR007",,"ARN001","ARS007","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070030-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","53"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070031","Bronze Basic Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070031-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","54"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070031","Bronze Basic Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070031-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","55"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070031","Bronze Basic Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","56"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070031","Bronze Basic Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070031-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","57"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070032","Bronze Premier Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070032-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","58"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070032","Bronze Premier Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070032-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","59"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070032","Bronze Premier Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","60"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070032","Bronze Premier Saver Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070032-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","61"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070036","Catastrophic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070036-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","62"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070036","Catastrophic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070036-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","63"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070037","Bronze Basic Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070037-00","Standard Bronze Off Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","64"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070037","Bronze Basic Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070037-01","Standard Bronze On Exchange Plan",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","65"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070037","Bronze Basic Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","66"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070037","Bronze Basic Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB5000I-QCRX901M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070037-03","Limited Cost Sharing Plan Variation",,"0.584032356739044","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","5000","0","1140","150","5000","0","140","80","67"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070038","Bronze Premier Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070038-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","68"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070038","Bronze Premier Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070038-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","69"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070038","Bronze Premier Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","0","0","0","150","0","0","0","80","70"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070038","Bronze Premier Saver Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF001","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EB2500I-QCRX900M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070038-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","2500","0","2390","150","2500","0","1390","80","71"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070042","Catastrophic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070042-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","72"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","1","70525","AR","Individual","No","71-0794605","70525AR0070042","Catastrophic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF004","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EC6350I-QCRX907M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070042-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$9,850","$19,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,850","$19,700","Not Applicable","Not Applicable","6350","0","0","150","5270","0","0","80","73"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070004","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070004-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","4"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070004","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070004-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","5"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070004","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","6"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070004","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070004-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","7"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070005","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070005-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","8"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070005","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070005-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","9"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070005","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","10"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070005","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070005-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","11"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070010","Gold Enhanced Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070010-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","12"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070010","Gold Enhanced Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070010-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","13"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070010","Gold Enhanced Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","14"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070010","Gold Enhanced Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070010-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","15"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070011","Gold Premier Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070011-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","16"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070011","Gold Premier Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070011-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","17"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070011","Gold Premier Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","18"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070011","Gold Premier Plus","70525AR007",,"ARN001","ARS002","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070011-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","19"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070016","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070016-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","20"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070016","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070016-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","21"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070016","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","22"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070016","Gold Enhanced Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070016-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","23"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070017","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070017-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","24"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070017","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070017-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","25"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070017","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","26"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070017","Gold Premier Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070017-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","27"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070022","Gold Enhanced Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070022-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","28"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070022","Gold Enhanced Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070022-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","29"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070022","Gold Enhanced Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070022-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","30"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070022","Gold Enhanced Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070022-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","31"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070023","Gold Premier Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070023-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","32"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070023","Gold Premier Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070023-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","33"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070023","Gold Premier Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070023-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","34"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070023","Gold Premier Plus","70525AR007",,"ARN001","ARS004","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070023-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","35"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070028","Gold Enhanced Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070028-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","36"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070028","Gold Enhanced Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070028-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","37"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070028","Gold Enhanced Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070028-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","38"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070028","Gold Enhanced Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070028-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","39"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070029","Gold Premier Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070029-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","40"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070029","Gold Premier Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070029-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","41"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070029","Gold Premier Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070029-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","42"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070029","Gold Premier Plus","70525AR007",,"ARN001","ARS007","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070029-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","43"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070034","Gold Enhanced Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070034-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","44"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070034","Gold Enhanced Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070034-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","45"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070034","Gold Enhanced Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","46"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070034","Gold Enhanced Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070034-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","47"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070035","Gold Premier Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070035-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","48"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070035","Gold Premier Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070035-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","49"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070035","Gold Premier Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070035-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","50"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070035","Gold Premier Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070035-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","51"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070040","Gold Enhanced Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070040-00","Standard Gold Off Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","52"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070040","Gold Enhanced Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070040-01","Standard Gold On Exchange Plan",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","53"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070040","Gold Enhanced Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070040-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","54"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070040","Gold Enhanced Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG1000I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070040-03","Limited Cost Sharing Plan Variation",,"0.798510611057281","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$6,500","$13,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"1000","20","1250","150","1000","640","220","80","55"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070041","Gold Premier Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070041-00","Standard Gold Off Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","56"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070041","Gold Premier Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070041-01","Standard Gold On Exchange Plan",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","57"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070041","Gold Premier Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070041-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"0","0","0","150","0","0","0","80","58"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","2","70525","AR","Individual","No","71-0794605","70525AR0070041","Gold Premier Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF003","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/EG0500I-QCRX906M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070041-03","Limited Cost Sharing Plan Variation",,"0.813816487789154","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"500","20","1350","150","500","780","240","80","59"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","4"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","5"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","6"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","7"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","8"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070003","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070003-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","9"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","10"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","11"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","12"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","13"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","14"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070009","Silver Basic Plus","70525AR007",,"ARN001","ARS002","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070009-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","15"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","16"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","18"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","19"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","20"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070015","Silver Basic Plus Statewide Network","70525AR007",,"ARN001","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070015-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","21"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","22"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","23"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","24"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","25"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","26"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070021","Silver Basic Plus","70525AR007",,"ARN001","ARS004","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070021-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","27"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","28"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","29"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","30"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","31"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","32"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070027","Silver Basic Plus","70525AR007",,"ARN001","ARS007","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070027-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","33"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","34"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","35"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","36"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","37"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","38"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070033","Silver Basic Plus Central Arkansas High Value Network","70525AR007",,"ARN002","ARS001","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070033-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","39"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-01","Standard Silver On Exchange Plan",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","40"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","41"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-03","Limited Cost Sharing Plan Variation",,"0.69881671667099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$4,450","$0","$150","$150","$2,920","$0","$80","42"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-04","73% AV Level Silver Plan",,"0.735499143600464","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$3,510","$0","$150","$150","$2,640","$0","$80","43"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-05","87% AV Level Silver Plan",,"0.860474407672882","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$1,490","$0","$150","$150","$1,480","$0","$80","44"
"2014","AR","70525","SERFF","8","2014-01-23 12:49:01","3","70525","AR","Individual","No","71-0794605","70525AR0070039","Silver Basic Plus Northwest Arkansas High Value Network","70525AR007",,"ARN003","ARS003","ARF002","New","POS","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/ES0150I-QCRX902M.pdf",,"https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/QualChoice_Marketplace_Plans.pdf","https://www.qualchoice.com/%21userfiles/pdfs/Products%20and%20Services/essential_formulary.pdf","70525AR0070039-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$150","$520","$0","$150","$150","$380","$0","$80","45"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0940001","SHOP Dental-Pediatric","75293AR094","7427051652","ARN001","ARS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0940001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$100",,,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","SHOP (Small Group)","No","71-0226428","75293AR0500001","SHOP Silver 2000-1","75293AR050","7427051652","ARN001","ARS001","ARF001","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefits reduction for medical care","Yes","https://secure.arkansasbluecross.com/employers/sbc.aspx","https://secure.arkansasbluecross.com/exchange/payment/group.aspx","http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0500001-01","Standard Silver On Exchange Plan",,"0.711843907833099","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000","75293AR026","7427051652","ARN001","ARS001","ARF026","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0260001-00","Standard Gold Off Exchange Plan",,"0.784468352794647","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","Yes","71-0226428","75293AR0400001"," Pediatric Dental","75293AR040","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0400001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","Yes","71-0226428","75293AR0400001"," Pediatric Dental","75293AR040","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0400001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000","75293AR026","7427051652","ARN001","ARS001","ARF026","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0260001-01","Standard Gold On Exchange Plan",,"0.784468352794647","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000","75293AR026","7427051652","ARN001","ARS001","ARF026","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0260001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","1","75293","AR","Individual","No","71-0226428","75293AR0260001","Gold 1000","75293AR026","7427051652","ARN001","ARS001","ARF026","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=30001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0260001-03","Limited Cost Sharing Plan Variation",,"0.784468352794647","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","SHOP (Small Group)","No","71-0226428","75293AR0510001","SHOP Bronze 3000","75293AR051","7427051652","ARN001","ARS001","ARF001","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefits reduction for medical care","Yes","https://secure.arkansasbluecross.com/employers/sbc.aspx","https://secure.arkansasbluecross.com/exchange/payment/group.aspx","http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0510001-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$3,000","$6,000","$3,000","$6,000",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0950001","SHOP Dental Silver","75293AR095","7427051652","ARN001","ARS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0950001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$100",,,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","Individual","Yes","71-0226428","75293AR0410001","Dental Gold","75293AR041","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0410001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0960001","SHOP Dental Gold","75293AR096","7427051652","ARN001","ARS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0960001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","Individual","Yes","71-0226428","75293AR0410001","Dental Gold","75293AR041","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0410001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","Individual","Yes","71-0226428","75293AR0420001"," Dental Gold Plus Vision","75293AR042","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0420001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","2","75293","AR","Individual","Yes","71-0226428","75293AR0420001"," Dental Gold Plus Vision","75293AR042","7427051652","ARN001","ARS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.89",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0420001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$20","$40",,,,,"$20","$40","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","Yes","71-0226428","75293AR0430001","Dental Silver","75293AR043","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0430001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$100",,,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-00","Standard Silver Off Exchange Plan",,"0.718138813972473","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0970001","Small Group Dental-Pediatric","75293AR097","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0970001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$100",,,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","Yes","71-0226428","75293AR0430001","Dental Silver","75293AR043","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.88",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Benefit reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","https://secure.arkansasbluecross.com/LookingForInsurance/IndividualAndFamilies/2014/demographics.aspx?productDesc=dental%20plan&productType=D",,"75293AR0430001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$100",,,,,"$50","$100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-01","Standard Silver On Exchange Plan",,"0.718138813972473","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-03","Limited Cost Sharing Plan Variation",,"0.718138813972473","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-04","73% AV Level Silver Plan",,"0.739495098590851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0980001","Small Group Dental-Silver 1","75293AR098","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0980001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","Individual","No","71-0226428","75293AR0300001","Bronze 6200","75293AR030","7427051652","ARN001","ARS001","ARF095","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0300001-00","Standard Bronze Off Exchange Plan",,"0.619811832904816","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400","30%",,,,"$12,400","$24,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","Individual","No","71-0226428","75293AR0300001","Bronze 6200","75293AR030","7427051652","ARN001","ARS001","ARF095","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0300001-01","Standard Bronze On Exchange Plan",,"0.619811832904816","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400","30%",,,,"$12,400","$24,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR0990001","Small Group Dental-Silver 2","75293AR099","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR0990001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","Individual","No","71-0226428","75293AR0300001","Bronze 6200","75293AR030","7427051652","ARN001","ARS001","ARF095","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0300001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1000001","Small Group Dental-Gold 1","75293AR100","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1000001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980001","Gold $5 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73700","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980001-03","Limited Cost Sharing Plan Variation","78.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"6"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-01","Standard Silver On Exchange Plan","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"7"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"8"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-03","Limited Cost Sharing Plan Variation","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"9"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"10"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$10",,,"11"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","Individual","Yes","75-1233841","48664DE0010001","Dentegra Dental PPO Children's Plan 70","48664DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010001",,"48664DE0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","Individual","Yes","75-1233841","48664DE0010002","Dentegra Dental PPO Children's Plan 85","48664DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010002",,"48664DE0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020002",,"48664DE0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Gold $5 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979874166247713",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73300","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Gold $5 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979874166247713",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73300","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0160001","Gold $5 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979874166247713",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73300","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Gold $5 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981871091606239",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73307","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","7"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Gold $5 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981871091606239",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73307","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0180001","Gold $5 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981871091606239",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73307","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","9"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-05","87% AV Level Silver Plan",,"0.875786900520325","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0270001","Silver 2500","75293AR027","7427051652","ARN001","ARS001","ARF083","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0270001-06","94% AV Level Silver Plan",,"0.947779357433319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$754","$1,508",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-00","Standard Silver Off Exchange Plan",,"0.709102749824524","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-01","Standard Silver On Exchange Plan",,"0.709102749824524","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-03","Limited Cost Sharing Plan Variation",,"0.709102749824524","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-04","73% AV Level Silver Plan",,"0.735491275787354","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","3","75293","AR","Individual","No","71-0226428","75293AR0280001","Silver 3500","75293AR028","7427051652","ARN001","ARS001","ARF089","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=32007","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0280001-05","87% AV Level Silver Plan",,"0.875786900520325","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","Individual","Yes","75-1233841","48664DE0010002","Dentegra Dental PPO Children's Plan 85","48664DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010002",,"48664DE0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020002",,"48664DE0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","3","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020006",,"48664DE0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","Individual","No","71-0226428","75293AR0300001","Bronze 6200","75293AR030","7427051652","ARN001","ARS001","ARF095","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23003","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0300001-03","Limited Cost Sharing Plan Variation",,"0.619811832904816","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,200","$12,400","30%",,,,"$12,400","$24,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1040001","Small Group Dental-Gold 3","75293AR104","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1040001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1060001","Small Group Dental -Silver V1","75293AR106","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1060001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","Individual","Yes","75-1233841","48664DE0010001","Dentegra Dental PPO Children's Plan 70","48664DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010001",,"48664DE0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020001",,"48664DE0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","1","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020001",,"48664DE0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","3","48664","DE","Individual","Yes","75-1233841","48664DE0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","48664DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010006",,"48664DE0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","3","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020006",,"48664DE0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","3","48664","DE","Individual","Yes","75-1233841","48664DE0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","48664DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.18",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010006",,"48664DE0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","4","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020004",,"48664DE0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","4","48664","DE","Individual","Yes","75-1233841","48664DE0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","48664DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010004",,"48664DE0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","4","48664","DE","SHOP (Small Group)","Yes","75-1233841","48664DE0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","48664DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0020004",,"48664DE0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","48664","SERFF","7","2014-01-22 11:51:12","4","48664","DE","Individual","Yes","75-1233841","48664DE0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","48664DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/de/de0010004",,"48664DE0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","61298","SERFF","1","2013-08-01 21:15:43","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0040002","EHB High PPO","61298DE004",,"DEN001","DES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.76",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"61298DE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1070001","Small Group Dental-Silver V2","75293AR107","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1070001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1080001","Small Group Dental-Gold V1","75293AR108","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1080001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","4","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1100001","Small Group Dental -Gold V3","75293AR110","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1100001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1010001","Small Group Dental-Silver 3","75293AR101","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1010001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300","75293AR031","7427051652","ARN001","ARS001","ARF049","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0310001-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","Individual","Yes","54-1808292","67775DE0010002","Select Plan","67775DE001",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0010002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030002","Select Plan","67775DE003",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0030002-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300","75293AR031","7427051652","ARN001","ARS001","ARF049","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0310001-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1020001","Small Group Dental -Gold 2","75293AR102","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1020001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300","75293AR031","7427051652","ARN001","ARS001","ARF049","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0310001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1030001","Small Group Dental-Silver 4","75293AR103","7427051652","ARN001","ARS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.07",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1030001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","Individual","No","71-0226428","75293AR0310001","Bronze 6300","75293AR031","7427051652","ARN001","ARS001","ARF049","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=25001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0310001-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1050001","Small Group Dental-Gold 4","75293AR105","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1050001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1090001","Small Group Dental-Gold V2","75293AR109","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1090001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","5","75293","AR","SHOP (Small Group)","Yes","71-0226428","75293AR1110001","Small Group Dental-Gold V4","75293AR111","7427051652","ARN001","ARS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Benefit Reduction for dental care","Yes",,"https://secure.arkansasbluecross.com/exchange/payment/group.aspx",,,"75293AR1110001-00","Standard High Off Exchange Plan","84.10%",,,,"No","100%",,"$700","Not Applicable",,,"$700","Not Applicable","$700","Not Applicable",,,,,,,,,,,,,,,,,"$20","Not Applicable",,,,,"$20","Not Applicable","$20","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 5500","75293AR037","7427051652","ARN001","ARS001","ARF040","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0370001-00","Standard Bronze Off Exchange Plan",,"0.618733704090118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 5500","75293AR037","7427051652","ARN001","ARS001","ARF040","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0370001-01","Standard Bronze On Exchange Plan",,"0.618733704090118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 5500","75293AR037","7427051652","ARN001","ARS001","ARF040","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0370001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","7","75293","AR","Individual","No","71-0226428","75293AR0370001","Bronze 5500","75293AR037","7427051652","ARN001","ARS001","ARF040","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=23002","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0370001-03","Limited Cost Sharing Plan Variation",,"0.618733704090118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","50%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","9","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500","75293AR025","7427051652","ARN001","ARS001","ARF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0250001-00","Standard Gold Off Exchange Plan",,"0.818483948707581","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","9","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500","75293AR025","7427051652","ARN001","ARS001","ARF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0250001-01","Standard Gold On Exchange Plan",,"0.818483948707581","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","9","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500","75293AR025","7427051652","ARN001","ARS001","ARF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0250001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","9","75293","AR","Individual","No","71-0226428","75293AR0250001","Gold 500","75293AR025","7427051652","ARN001","ARS001","ARF004","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=28001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0250001-03","Limited Cost Sharing Plan Variation",,"0.818483948707581","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720003","Bronze Deductible Only PPO HSA Eligible","13537DE072",,"DEN001","DES001","DEF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73727","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720003-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","$12,700","$25,400","$6,300","$0",,,"$6,300","$0",,,"15"
"2014","DE","19005","SERFF","1","2013-08-01 21:15:43","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0040002","EHB High PPO","19005DE004",,"DEN001","DES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.52",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"19005DE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","19005","SERFF","1","2013-08-01 21:15:43","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0030002","EHB High Passive","19005DE003",,"DEN001","DES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$53.64",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"19005DE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020001",,"26018DE0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020001",,"26018DE0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","Individual","Yes","51-0228088","26018DE0010001","Delta Dental PPO Plan 70 for Children","26018DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010001",,"26018DE0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","Individual","Yes","51-0228088","26018DE0010002","Delta Dental PPO Plan85 for Children","26018DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010002",,"26018DE0010002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020002",,"26018DE0020002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","Individual","Yes","51-0228088","26018DE0010002","Delta Dental PPO Plan85 for Children","26018DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010002",,"26018DE0010002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020002",,"26018DE0020002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","3","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020006","Delta Dental PPO Plan 70 for Children + Basic Plan for Adults for small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020006",,"26018DE0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","3","26018","DE","Individual","Yes","51-0228088","26018DE0010006","Delta Dental PPO Plan 70 for Children + Basic Plan for Adults","26018DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010006",,"26018DE0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","3","26018","DE","Individual","Yes","51-0228088","26018DE0010006","Delta Dental PPO Plan 70 for Children + Basic Plan for Adults","26018DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010006",,"26018DE0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","3","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020006","Delta Dental PPO Plan 70 for Children + Basic Plan for Adults for small Businesses","26018DE002",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020006",,"26018DE0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","4","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businessses","26018DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020004",,"26018DE0020004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","4","26018","DE","Individual","Yes","51-0228088","26018DE0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","26018DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010004",,"26018DE0010004-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","4","26018","DE","Individual","Yes","51-0228088","26018DE0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","26018DE001",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010004",,"26018DE0010004-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","4","26018","DE","SHOP (Small Group)","Yes","51-0228088","26018DE0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businessses","26018DE002",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","nationwide coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0020004",,"26018DE0020004-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0210001","Gold $5 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976569236059956",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73328","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","18"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0220001","Gold $5 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974804600520622",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73335","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","19"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0220001","Gold $5 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974804600520622",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73335","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0220001","Gold $5 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974804600520622",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73335","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","21"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Gold $5 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979966491531339",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73356","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","22"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Gold $5 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979966491531339",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73356","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","10","75293","AR","Individual","No","71-0226428","75293AR0320001","Catastrophic","75293AR032","7427051652","ARN001","ARS001","ARF052","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0320001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","10","75293","AR","Individual","No","71-0226428","75293AR0320001","Catastrophic","75293AR032","7427051652","ARN001","ARS001","ARF052","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Benefit reduction for medical care","Yes","https://secure.arkansasbluecross.com/members/ViewSbc.aspx?id=27001","https://secure.arkansasbluecross.com/exchange/payment/individual.aspx","http://www.arkansasbluecross.com/lookingforinsurance/individualandfamilies/medical_plans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/12-03-13 bcbs-ar member document-metallic comp.pdf","75293AR0320001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","AR","75293","SERFF","9","2014-01-22 11:51:12","15","75293","AR","SHOP (Small Group)","No","71-0226428","75293AR0450001","SHOP Gold 1500","75293AR045","7427051652","ARN001","ARS001","ARF001","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care","Yes","Coinsurance reduction for medical care","Yes","https://secure.arkansasbluecross.com/employers/sbc.aspx","https://secure.arkansasbluecross.com/exchange/payment/group.aspx","http://www.arkansasbluecross.com/lookingforinsurance/smallgroupplans.aspx","http://www.arkansasbluecross.com/doclib/documents/pharmacy/exchange/exchange Formulary.pdf","75293AR0450001-01","Standard Gold On Exchange Plan",,"0.785393238067627","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720001","Gold $5 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73718","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720001-01","Standard Gold On Exchange Plan","78.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","$8,150","$16,300","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"4"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720001","Gold $5 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73718","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"5"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720001","Gold $5 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73718","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720001-03","Limited Cost Sharing Plan Variation","78.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","$8,150","$16,300","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"6"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-01","Standard Silver On Exchange Plan","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"7"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"8"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-03","Limited Cost Sharing Plan Variation","70.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"9"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"10"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","$8,150","$16,300","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$10",,,"11"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720002","Silver $10 Copay PPO Plan","13537DE072",,"DEN001","DES001","DEF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73721","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","$6,400","$12,800","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$250",,,"$0","$25","$200",,"12"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720003","Bronze Deductible Only PPO HSA Eligible","13537DE072",,"DEN001","DES001","DEF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73727","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720003-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","$12,700","$25,400","$6,300","$0",,,"$6,300","$0",,,"13"
"2014","DE","13537","SERFF","5","2013-11-27 09:24:34","1","13537","DE","Individual","No","75-1296086","13537DE0720003","Bronze Deductible Only PPO HSA Eligible","13537DE072",,"DEN001","DES001","DEF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73727","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppode","http://www.c1formularyhix.com","13537DE0720003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0",,,"$0","$0",,,"14"
"2014","DE","19005","SERFF","1","2013-08-01 21:15:43","1","19005","DE","SHOP (Small Group)","Yes","93-0242990","19005DE0030001","EHB Low Passive","19005DE003",,"DEN001","DES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.32",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"19005DE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","26018","SERFF","9","2014-01-23 12:49:01","1","26018","DE","Individual","Yes","51-0228088","26018DE0010001","Delta Dental PPO Plan 70 for Children","26018DE001",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.77",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"deltadentalins.com/hx/checkout","deltadentalins.com/hx/de/de0010001",,"26018DE0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","1","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0440001","Health Savings PPO   H S A $2000/80","76168DE044",,"DEN001","DES001","DEF007","New","PPO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide Network In-Network Only","Yes","BlueCard Network","Yes","https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0440001-01","Standard Silver On Exchange Plan",,"0.698870837688446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","1","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0450001","Health Savings EPO   H S A $3500/90","76168DE045",,"DEN001","DES001","DEF003","New","EPO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide Network In-Network Only","Yes","BlueCard Network       In-Network Only","Yes","https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0450001-01","Standard Bronze On Exchange Plan",,"0.615489542484283","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-01","Standard Silver On Exchange Plan","69.96%","0.699561893939972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430002","Shared Cost EPO Basic $2000/75","76168DE043",,"DEN001","DES001","DEF006","New","EPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide In-Network Only","Yes","BlueCard Network      In-Network Only","Yes","https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430002-01","Standard Silver On Exchange Plan",,"0.694727122783661","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","4","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0060001","Guardian Family Advantage","90955DE006",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0060001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","4","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0080001","Guardian Family Essentials","90955DE008",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0080001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","4","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0080001","Guardian Family Essentials","90955DE008",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0080001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980002","Silver $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73703","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$250",,,"$0","$25","$200",,"12"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980003","Bronze $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73709","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,600","$500",,,"$5,600","$10",,,"13"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980003","Bronze $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73709","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"$0","$0",,,"14"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980003","Bronze $10 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73709","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,600","$500",,,"$5,600","$10",,,"15"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980004","Bronze Deductible Only HMO HSA Eligible","81914DE098",,"DEN001","DES001","DEF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73712","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0",,,"$6,300","$0",,,"16"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980004","Bronze Deductible Only HMO HSA Eligible","81914DE098",,"DEN001","DES001","DEF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73712","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0",,,"$0","$0",,,"17"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980004","Bronze Deductible Only HMO HSA Eligible","81914DE098",,"DEN001","DES001","DEF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73712","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0",,,"$6,300","$0",,,"18"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","2","81914","DE","Individual","No","51-0293139","81914DE0980005","Catastrophic 100% HMO Plan","81914DE098",,"DEN001","DES001","DEF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73715","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0",,,"$6,350","$0",,,"4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","24"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","25"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","26"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","27"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","28"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"29"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","30"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","31"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","32"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0210002","Silver $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973544583910867",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73329","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","33"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","34"
"2014","DE","61298","SERFF","1","2013-08-01 21:15:43","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0040001","EHB Low PPO","61298DE004",,"DEN001","DES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"61298DE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","61298","SERFF","1","2013-08-01 21:15:43","1","61298","DE","SHOP (Small Group)","Yes","47-0098400","61298DE0030002","EHB High Passive","61298DE003",,"DEN001","DES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$52.76",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"61298DE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","Individual","Yes","54-1808292","67775DE0010001","Select Plan Kids","67775DE001",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0010001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030001","Select Plan Kids","67775DE003",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0030001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","Individual","Yes","54-1808292","67775DE0010001","Select Plan Kids","67775DE001",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0010001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030001","Select Plan Kids","67775DE003",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0030001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040001","Access PPO Kids","67775DE004",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0040001-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","Individual","Yes","54-1808292","67775DE0020001","Access PPO Kids","67775DE002",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0020001-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","Individual","Yes","54-1808292","67775DE0020001","Access PPO Kids","67775DE002",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0020001-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","1","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040001","Access PPO Kids","67775DE004",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0040001-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","Individual","Yes","54-1808292","67775DE0010002","Select Plan","67775DE001",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0010002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0030002","Select Plan","67775DE003",,"DEN001","DES001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$16.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/de14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0030002-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040002","Access PPO","67775DE004",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0040002-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","Individual","Yes","54-1808292","67775DE0020002","Access PPO","67775DE002",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0020002-00","Standard Low Off Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","SHOP (Small Group)","Yes","54-1808292","67775DE0040002","Access PPO","67775DE004",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0040002-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","6","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-01","Standard Gold On Exchange Plan","81.04%","0.810413002967834","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","6","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","6","76168","DE","Individual","No","51-0020405","76168DE0410002","Shared Cost Blue EPO 0","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410002-03","Limited Cost Sharing Plan Variation","81.04%","0.810413002967834","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","7","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-01","Standard Platinum On Exchange Plan","89.15%","0.891458928585052","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","7","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","7","76168","DE","Individual","No","51-0020405","76168DE0410004","Shared Cost Blue EPO 300","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410004-03","Limited Cost Sharing Plan Variation","89.15%","0.891458928585052","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$300","$600","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","8","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1350","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-01","Standard Gold On Exchange Plan","81.87%","0.81870311498642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,350","$2,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","8","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1350","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","8","76168","DE","Individual","No","51-0020405","76168DE0410011","Shared Cost Blue EPO 1350","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410011-03","Limited Cost Sharing Plan Variation","81.87%","0.81870311498642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,350","$2,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","9","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-01","Standard Gold On Exchange Plan","81.83%","0.81830769777298","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","3","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0070001","Guardian Family Essentials Plus","90955DE007",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0070001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","3","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0070001","Guardian Family Essentials Plus","90955DE007",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0070001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","4","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0060001","Guardian Family Advantage","90955DE006",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0060001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Gold $5 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980264565162981",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73314","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","10"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Gold $5 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980264565162981",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73314","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0170001","Gold $5 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980264565162981",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73314","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","12"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Gold $5 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978841630641877",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73321","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","13"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Gold $5 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978841630641877",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73321","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0190001","Gold $5 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978841630641877",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73321","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","15"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0210001","Gold $5 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976569236059956",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73328","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","16"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0210001","Gold $5 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976569236059956",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73328","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","1","18973","IA","Individual","No","42-1244752","18973IA0250001","Gold $5 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979966491531339",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73356","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","24"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","7"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","8"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0160002","Silver $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977278012585555",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73301","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","9"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","10"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","12"
"2014","DE","67775","SERFF","6","2013-11-29 08:33:31","2","67775","DE","Individual","Yes","54-1808292","67775DE0020002","Access PPO","67775DE002",,"DEN002","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/de14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-delaware",,"67775DE0020002-01","Standard Low On Exchange Plan","70.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$200",,,,,"$100","$200","$100","$200",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","1","76168","DE","Individual","No","51-0020405","76168DE0400001","Major Events Blue EPO 6350","76168DE040",,"DEN001","DES001","DEF001","New","EPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0400001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-03","Limited Cost Sharing Plan Variation","69.96%","0.699561893939972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-04","73% AV Level Silver Plan","73.11%","0.731100738048553","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-05","87% AV Level Silver Plan","86.90%","0.868964791297913","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","2","76168","DE","Individual","No","51-0020405","76168DE0410008","Shared Cost Blue EPO 3000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410008-06","94% AV Level Silver Plan","93.31%","0.933149755001068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","3","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430003","Shared Cost EPO Basic $5250/90","76168DE043",,"DEN001","DES001","DEF003","New","EPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide In-Network Only","Yes","BlueCard Network      In-Network Only","Yes","https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430003-01","Standard Bronze On Exchange Plan",,"0.603456914424896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","3","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 5250","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-01","Standard Bronze On Exchange Plan","59.81%","0.598140716552734","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","3","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 5250","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","3","76168","DE","Individual","No","51-0020405","76168DE0410010","Shared Cost Blue EPO 5250","76168DE041",,"DEN001","DES001","DEF003","New","EPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410010-03","Limited Cost Sharing Plan Variation","59.81%","0.598140716552734","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,250","$10,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","SHOP (Small Group)","No","51-0020405","76168DE0430001","Shared Cost EPO Basic $1000/75","76168DE043",,"DEN001","DES001","DEF005","New","EPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","BlueCard WorldWide In-Network Only","Yes","BlueCard Network      In-Network Only","Yes","https://www.highmarkbcbsde.com/chmptl/chm/jsp/sbcSearch.do","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0430001-01","Standard Gold On Exchange Plan",,"0.805035412311554","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-01","Standard Silver On Exchange Plan","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-03","Limited Cost Sharing Plan Variation","71.70%","0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-04","73% AV Level Silver Plan","73.89%","0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-05","87% AV Level Silver Plan","86.74%","0.867380082607269","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420004","Health Savings Blue EPO 3000","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420004-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 1800","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-01","Standard Gold On Exchange Plan","80.39%","0.803948640823364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 1800","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","4","76168","DE","Individual","No","51-0020405","76168DE0420002","Health Savings Blue EPO 1800","76168DE042",,"DEN001","DES001","DEF001","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","Same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0420002-03","Limited Cost Sharing Plan Variation","80.39%","0.803948640823364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,800","$3,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","5","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","No","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-01","Standard Gold On Exchange Plan","78.36%","0.783622145652771","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","5","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","No","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","5","76168","DE","Individual","No","51-0020405","76168DE0410006","Shared Cost Blue EPO 1000","76168DE041",,"DEN001","DES001","DEF002","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","No","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410006-03","Limited Cost Sharing Plan Variation","78.36%","0.783622145652771","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","9","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","9","76168","DE","Individual","No","51-0020405","76168DE0410012","Shared Cost Blue EPO 750","76168DE041",,"DEN001","DES001","DEF004","New","EPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0410012-03","Limited Cost Sharing Plan Variation","81.83%","0.81830769777298","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","10","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-01","Standard Gold On Exchange Plan","81.13%","0.811321556568146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","10","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","DE","76168","SERFF","11","2014-03-20 11:33:30","10","76168","DE","Individual","No","51-0020405","76168DE0560001","Shared Cost Blue PPO 1500","76168DE056",,"DEN001","DES001","DEF004","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmarkbcbsde.com/sbc/bcbsde.html","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","https://client.formularynavigator.com/Search.aspx?siteCode=1546534148","76168DE0560001-03","Limited Cost Sharing Plan Variation","81.13%","0.811321556568146","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980001","Gold $5 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73700","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980001-01","Standard Gold On Exchange Plan","78.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"4"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE0990001","Gold $0 Copay HMO Plan","81914DE099",,"DEN001","DES001","DEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73736",,,"http://de.coventryproviders.com","81914DE0990001-01","Standard Gold On Exchange Plan","78.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$250",,,"$1,250","$0",,,"4"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","Individual","No","51-0293139","81914DE0980001","Gold $5 Copay HMO Plan","81914DE098",,"DEN001","DES001","DEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://coventryhealthcare.com/de73700","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventyone.com/hmode","http://www.c1formularyhix.com","81914DE0980001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"5"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE0990002","Silver $10 Copay HMO Plan","81914DE099",,"DEN001","DES001","DEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73737",,,"http://de.coventryproviders.com","81914DE0990002-01","Standard Silver On Exchange Plan","70.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$250",,,"$2,000","$10",,,"5"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","1","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE0990003","Bronze Deductible Only HMO HSA Eligible","81914DE099",,"DEN001","DES001","DEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73738",,,"http://de.coventryproviders.com","81914DE0990003-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0",,,"$6,300","$0",,,"6"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","2","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE1000001","Gold $0 Copay POS Plan","81914DE100",,"DEN001","DES001","DEF001","New","POS","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73739",,,"http://de.coventryproviders.com","81914DE1000001-01","Standard Gold On Exchange Plan","78.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"$4,900","$9,800","$6,150","$12,300","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$250",,,"$1,250","$0",,,"4"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","2","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE1000002","Silver $10 Copay POS Plan","81914DE100",,"DEN001","DES001","DEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73740",,,"http://de.coventryproviders.com","81914DE1000002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,300","$10,600","$7,300","$14,600","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$250",,,"$2,000","$10",,,"5"
"2014","DE","81914","SERFF","6","2013-11-27 09:24:34","2","81914","DE","SHOP (Small Group)","No","51-0293139","81914DE1000003","Bronze Deductible Only POS HSA Eligible","81914DE100",,"DEN001","DES001","DEF003","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","www.coventryhealthcare.com/DE73741",,,"http://de.coventryproviders.com","81914DE1000003-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$7,100","$14,200","$13,400","$26,800","$6,300","$0",,,"$6,300","$0",,,"6"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0090001","Guardian Pediatric Advantage","90955DE009",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0090001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0090001","Guardian Pediatric Advantage","90955DE009",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0090001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0100001","Guardian Pediatric Essentials","90955DE010",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0100001-00","Standard Low Off Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","1","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0100001","Guardian Pediatric Essentials","90955DE010",,"DEN001","DES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.15",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0100001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0050001","Guardian Family Advantage Plus","90955DE005",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0050001-00","Standard High Off Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","DE","90955","SERFF","4","2013-09-20 12:46:38","2","90955","DE","SHOP (Small Group)","Yes","13-5123390","90955DE0050001","Guardian Family Advantage Plus","90955DE005",,"DEN001","DES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.16",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"90955DE0050001-01","Standard High On Exchange Plan","85.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","13"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","14"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0180002","Silver $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979533927833732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73308","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","15"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","16"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","18"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","19"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","20"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0170002","Silver $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977719593167663",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73315","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","21"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0190002","Silver $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976111477781261",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73322","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","22"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"35"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","36"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","37"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","38"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0220002","Silver $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971551074713895",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73336","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","39"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","40"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"41"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","42"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","43"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","44"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0250002","Silver $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.977381992077512",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73357","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","45"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-01","Standard Silver On Exchange Plan","69.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$800","$40","$200","$1,400","$1,500","$0","$40","46"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-03","Limited Cost Sharing Plan Variation","69.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$800","$40","$200","$1,400","$1,500","$0","$40","48"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-04","73% AV Level Silver Plan","72.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$800","$40","$200","$1,400","$1,500","$0","$40","49"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","50"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","2","18973","IA","Individual","No","42-1244752","18973IA0330001","Silver POS IHAWP","18973IA033",,"IAN006","IAS008","IAF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978871243328312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73494","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0330001-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","51"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0160003","Bronze $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972521157298304",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73305","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0160003","Bronze $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972521157298304",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73305","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0160003","Bronze $10 Copay HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972521157298304",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73305","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0180003","Bronze $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975250386186584",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73312","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","7"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0180003","Bronze $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975250386186584",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73312","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0180003","Bronze $10 Copay HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975250386186584",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73312","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","9"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0170003","Bronze $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973054768788145",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73319","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","10"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0170003","Bronze $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973054768788145",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73319","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0170003","Bronze $10 Copay POS MIPPA","18973IA017",,"IAN007","IAS005","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973054768788145",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73319","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","12"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0190003","Bronze $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971109739274799",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73326","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","13"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0190003","Bronze $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971109739274799",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73326","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0190003","Bronze $10 Copay POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971109739274799",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73326","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","15"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0210003","Bronze $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.968002938081249",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73333","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","16"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0210003","Bronze $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.968002938081249",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73333","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0220005","Bronze Deductible Only POS HSA Eligible UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.963312234558795",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73428","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0220005","Bronze Deductible Only POS HSA Eligible UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.963312234558795",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73428","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","21"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0250005","Bronze Deductible Only POS HSA Eligible Plan","18973IA025",,"IAN006","IAS008","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970838963792414",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73437","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","22"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0250005","Bronze Deductible Only POS HSA Eligible Plan","18973IA025",,"IAN006","IAS008","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970838963792414",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73437","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0250005","Bronze Deductible Only POS HSA Eligible Plan","18973IA025",,"IAN006","IAS008","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970838963792414",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73437","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","24"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070001-00","Standard Platinum Off Exchange Plan",,"0.911583483219147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050001-00","Standard Platinum Off Exchange Plan",,"0.907075166702271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050003-00","Standard Gold Off Exchange Plan",,"0.808068215847015","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070011","Platinum $1000 - 0% $30 OV Expanded","27651IA007",,"IAN002","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070011-00","Standard Platinum Off Exchange Plan",,"0.911583483219147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050003-01","Standard Gold On Exchange Plan",,"0.808068215847015","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070011","Platinum $1000 - 0% $30 OV Expanded","27651IA007",,"IAN002","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070011-01","Standard Platinum On Exchange Plan",,"0.911583483219147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070012","Platinum $500 - 20% $15 OV Expanded","27651IA007",,"IAN002","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070012-00","Standard Platinum Off Exchange Plan",,"0.882185757160187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070012","Platinum $500 - 20% $15 OV Expanded","27651IA007",,"IAN002","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070012-01","Standard Platinum On Exchange Plan",,"0.882185757160187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0210003","Bronze $10 Copay POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.968002938081249",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73333","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","18"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0220003","Bronze $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965589804494472",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73340","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","19"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0220003","Bronze $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965589804494472",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73340","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0220003","Bronze $10 Copay POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965589804494472",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73340","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","21"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0250003","Bronze $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972647352939174",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73361","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","22"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0250003","Bronze $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972647352939174",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73361","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","3","18973","IA","Individual","No","42-1244752","18973IA0250003","Bronze $10 Copay POS Plan","18973IA025",,"IAN006","IAS008","IAF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972647352939174",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73361","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","24"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0160004","Catastrophic 100% HMO Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.957031780524317",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73306","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0180004","Catastrophic 100% HMO Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.961308398781421",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73313","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0170004","Catastrophic 100% POS MIPPA","18973IA017",,"IAN007","IAS005","IAF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.957868089316239",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73320","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0190004","Catastrophic 100% POS Patient Preferred","18973IA019",,"IAN003","IAS003","IAF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.954819353853703",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73327","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","7"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0210004","Catastrophic 100% POS UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.949947510057944",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73334","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","8"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0220004","Catastrophic 100% POS UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.946161646955698",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73341","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","9"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","4","18973","IA","Individual","No","42-1244752","18973IA0250004","Catastrophic 100% POS Plan","18973IA025",,"IAN006","IAS008","IAF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.957229568947801",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73440","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posia","www.c1formularyhix.com","18973IA0250004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","10"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0160005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970704388046938",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73416","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","4"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0160005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970704388046938",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73416","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0160005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","18973IA016",,"IAN001","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.970704388046938",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73416","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistia","www.c1formularyhix.com","18973IA0160005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","6"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0180005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973614777717836",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73419","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","7"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0180005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973614777717836",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73419","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0180005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","18973IA018",,"IAN002","IAS005","IAF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973614777717836",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73419","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonia","www.c1formularyhix.com","18973IA0180005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","9"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0170005","Bronze Deductible Only POS HSA Eligible MIPPA","18973IA017",,"IAN007","IAS005","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971273432049844",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73441","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","10"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0170005","Bronze Deductible Only POS HSA Eligible MIPPA","18973IA017",,"IAN007","IAS005","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971273432049844",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73441","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0170005","Bronze Deductible Only POS HSA Eligible MIPPA","18973IA017",,"IAN007","IAS005","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.971273432049844",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73441","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippaia","www.c1formularyhix.com","18973IA0170005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","12"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0190005","Bronze Deductible Only POS HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.969199220828458",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73422","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","13"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0190005","Bronze Deductible Only POS HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.969199220828458",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73422","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0190005","Bronze Deductible Only POS HSA Eligible Patient Preferred","18973IA019",,"IAN003","IAS003","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.969199220828458",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73422","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/pospatientpreferredia","www.c1formularyhix.com","18973IA0190005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","15"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0210005","Bronze Deductible Only POS HSA Eligible UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965885910604732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73425","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","16"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0210005","Bronze Deductible Only POS HSA Eligible UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965885910604732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73425","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0210005","Bronze Deductible Only POS HSA Eligible UnityPoint Health � Des Moines","18973IA021",,"IAN004","IAS001","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965885910604732",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73425","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0210005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","18"
"2014","IA","18973","SERFF","3","2013-11-27 09:24:34","5","18973","IA","Individual","No","42-1244752","18973IA0220005","Bronze Deductible Only POS HSA Eligible UnityPoint Health","18973IA022",,"IAN005","IAS006","IAF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.963312234558795",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/ia73428","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/POSUnityPointIA","www.c1formularyhix.com","18973IA0220005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","19"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050003","Gold $1500 - 30%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8M&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050003-03","Limited Cost Sharing Plan Variation",,"0.808068215847015","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050004-00","Standard Gold Off Exchange Plan",,"0.785712003707886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070014","Gold $1000 - 20% $40 OV Expanded","27651IA007",,"IAN002","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070014-00","Standard Gold Off Exchange Plan",,"0.795965492725372","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050001-01","Standard Platinum On Exchange Plan",,"0.907075166702271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070001","Platinum $1000 - 0% $30 OV","27651IA007",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8A&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070001-01","Standard Platinum On Exchange Plan",,"0.911583483219147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070002-00","Standard Platinum Off Exchange Plan",,"0.882185757160187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070002","Platinum $500 - 20% $15 OV","27651IA007",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8B&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070002-01","Standard Platinum On Exchange Plan",,"0.882185757160187","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050004-03","Limited Cost Sharing Plan Variation",,"0.785712003707886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-00","Standard Silver Off Exchange Plan",,"0.698473453521729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080005","CoOportunity Premier HSA Gold","71268IA008",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080005-01","Standard Gold On Exchange Plan","78.50%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050003","CoOportunity Premier HSA Gold","71268IA005",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$87.93","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $5500 - 20%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050010-01","Standard Bronze On Exchange Plan",,"0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver - 50%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070007-01","Standard Silver On Exchange Plan",,"0.712445914745331","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","52391","SERFF","1","2013-08-01 21:15:43","1","52391","IA","SHOP (Small Group)","Yes","47-0098400","52391IA0040001","EHB Low PPO","52391IA004",,"IAN001","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.04",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"52391IA0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010001","BEST Life Child Dental Plus","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plus_Plan.pdf",,"71051IA0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010002","BEST Life Child Dental","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plan.pdf",,"71051IA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-01","Standard Silver On Exchange Plan",,"0.698473453521729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-03","Limited Cost Sharing Plan Variation",,"0.698473453521729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050001","CoOportunity Premier Platinum","71268IA005",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,"$44.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050001-00","Standard Platinum Off Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050001","Platinum $1000 - 0%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8L&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050001-03","Limited Cost Sharing Plan Variation",,"0.907075166702271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6300 - 0%","27651IA008",,"IAN001","IAS001","IAF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-00","Standard Silver Off Exchange Plan",,"0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080004","Bronze HSA $6300 - 0%","27651IA008",,"IAN001","IAS001","IAF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-01","Standard Silver On Exchange Plan",,"0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080005","Silver HSA $2000 - 20% Expanded","27651IA008",,"IAN002","IAS001","IAF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080005-00","Standard Silver Off Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050002-00","Standard Platinum Off Exchange Plan",,"0.903730511665344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $1000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070004-00","Standard Gold Off Exchange Plan",,"0.795965492725372","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050002-01","Standard Platinum On Exchange Plan",,"0.903730511665344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070004","Gold $1000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070004-01","Standard Gold On Exchange Plan",,"0.795965492725372","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $2000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070006-00","Standard Silver Off Exchange Plan",,"0.711667835712433","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070006","Silver $2000 - 20% $40 OV","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070006-01","Standard Silver On Exchange Plan",,"0.711667835712433","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050002","Platinum $500 - 20%","27651IA005",,"IAN003","IAS001","IAF009","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8K&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050002-03","Limited Cost Sharing Plan Variation",,"0.903730511665344","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $2500 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060003-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070003-01","Standard Gold On Exchange Plan",,"0.817291140556335","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-03","Limited Cost Sharing Plan Variation",,"0.681622445583344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080006","Bronze HSA $2500 - 50% Expanded","27651IA008",,"IAN002","IAS001","IAF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080006-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","4","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0060001","Guardian Family Essentials","50730IA006",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0060001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","4","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0060001","Guardian Family Essentials","50730IA006",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0060001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","52391","SERFF","1","2013-08-01 21:15:43","1","52391","IA","SHOP (Small Group)","Yes","47-0098400","52391IA0040002","EHB High PPO","52391IA004",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.68",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"52391IA0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010006","BEST Dental Basic - Silver","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Basic_Plan_(Silver).pdf",,"71051IA0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070017","Silver - 50% Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070017-00","Standard Silver Off Exchange Plan",,"0.712445914745331","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0030001","Guardian Family Advantage Plus","50730IA003",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0030001-01","Standard High On Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","3","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0050001","Guardian Family Essentials Plus","50730IA005",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0050001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050004-01","Standard Gold On Exchange Plan",,"0.785712003707886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$3,500","$7,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070014","Gold $1000 - 20% $40 OV Expanded","27651IA007",,"IAN002","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8D&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070014-01","Standard Gold On Exchange Plan",,"0.795965492725372","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050004","Gold $3500 - 0%","27651IA005",,"IAN003","IAS001","IAF010","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8N&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070016","Silver $2000 - 20% $40 OV Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070016-00","Standard Silver Off Exchange Plan",,"0.711667835712433","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070016","Silver $2000 - 20% $40 OV Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8F&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070016-01","Standard Silver On Exchange Plan",,"0.711667835712433","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080001","CoOportunity Premier Platinum","71268IA008",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080001-00","Standard Platinum Off Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050001","CoOportunity Premier Platinum","71268IA005",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,"$44.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050001-01","Standard Platinum On Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-04","73% AV Level Silver Plan",,"0.723637223243713","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $2500 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060003-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080008","Bronze HSA $6300 - 0% Expanded","27651IA008",,"IAN002","IAS001","IAF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080008-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","3","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0050001","Guardian Family Essentials Plus","50730IA005",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0050001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","4","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0040001","Guardian Family Advantage","50730IA004",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0040001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","4","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0040001","Guardian Family Advantage","50730IA004",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0040001-01","Standard High On Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"71051IA0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010006","BEST Dental Basic - Silver","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Basic_Plan_(Silver).pdf",,"71051IA0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080002","CoOportunity Premier Gold","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080002-00","Standard Gold Off Exchange Plan",,"0.782301127910614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050003","CoOportunity Premier HSA Gold","71268IA005",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$87.93","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050003-01","Standard Gold On Exchange Plan","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080001","CoOportunity Premier Platinum","71268IA008",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080001-01","Standard Platinum On Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-04","73% AV Level Silver Plan",,"0.724468350410461","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-05","87% AV Level Silver Plan",,"0.87049925327301","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080007","Bronze HSA $5000 - 30% Expanded","27651IA008",,"IAN002","IAS001","IAF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080007-00","Standard Bronze Off Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-05","87% AV Level Silver Plan",,"0.864543795585632","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060002","Silver HSA $2000 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=G8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060002-06","94% AV Level Silver Plan",,"0.941158354282379","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080007","Bronze HSA $5000 - 30% Expanded","27651IA008",,"IAN002","IAS001","IAF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080007-01","Standard Bronze On Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050005","Silver $3500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8Q&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050005-06","94% AV Level Silver Plan",,"0.935769379138947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-00","Standard Silver Off Exchange Plan",,"0.686804115772247","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-01","Standard Silver On Exchange Plan",,"0.686804115772247","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"29"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-03","Limited Cost Sharing Plan Variation",,"0.686804115772247","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-04","73% AV Level Silver Plan",,"0.728021442890167","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-05","87% AV Level Silver Plan",,"0.872846245765686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","1","27651","IA","Individual","No","39-1807071","27651IA0050006","Silver $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8P&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050006-06","94% AV Level Silver Plan",,"0.935769379138947","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080008","Bronze HSA $6300 - 0% Expanded","27651IA008",,"IAN002","IAS001","IAF008","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=E8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080008-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $2500 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060003","Bronze HSA $2500 - 50%","27651IA006",,"IAN003","IAS001","IAF006","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=J8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060003-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $5500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060004-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $5500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060004-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $5500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060004","Bronze HSA $5500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=H8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060004-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $4500 - 20%","27651IA006",,"IAN003","IAS001","IAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060005-00","Standard Bronze Off Exchange Plan",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $4500 - 20%","27651IA006",,"IAN003","IAS001","IAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060005-01","Standard Bronze On Exchange Plan",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $4500 - 20%","27651IA006",,"IAN003","IAS001","IAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060005","Bronze HSA $4500 - 20%","27651IA006",,"IAN003","IAS001","IAF005","New","POS","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=I8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060005-03","Limited Cost Sharing Plan Variation",,"0.60315477848053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-00","Standard Silver Off Exchange Plan",,"0.685413300991058","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070003","Gold $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070003-00","Standard Gold Off Exchange Plan",,"0.817291140556335","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-01","Standard Silver On Exchange Plan",,"0.685413300991058","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $2000 - 20%","27651IA008",,"IAN001","IAS001","IAF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080001-00","Standard Silver Off Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080001","Silver HSA $2000 - 20%","27651IA008",,"IAN001","IAS001","IAF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080001-01","Standard Silver On Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $2500 - 50%","27651IA008",,"IAN001","IAS001","IAF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080002-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080002","Bronze HSA $2500 - 50%","27651IA008",,"IAN001","IAS001","IAF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080002-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5000 - 30%","27651IA008",,"IAN001","IAS001","IAF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080003-00","Standard Bronze Off Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080003","Bronze HSA $5000 - 30%","27651IA008",,"IAN001","IAS001","IAF007","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=D8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080003-01","Standard Bronze On Exchange Plan",,"0.588535189628601","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","Individual","No","39-1807071","27651IA0060001","Silver HSA $3500 - 0%","27651IA006",,"IAN003","IAS001","IAF008","New","POS","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=F8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0060001-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080005","Silver HSA $2000 - 20% Expanded","27651IA008",,"IAN002","IAS001","IAF005","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=A8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080005-01","Standard Silver On Exchange Plan",,"0.71393358707428","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","2","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0080006","Bronze HSA $2500 - 50% Expanded","27651IA008",,"IAN002","IAS001","IAF006","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=B8&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0080006-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010002","Delta Dental Premier Plan B-HM","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network dentist is not selected.","Yes","www.deltadentalia.com/mp/shop-bhm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010002-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","Individual","Yes","42-0959302","63366IA0020003","Delta Dental PPO Plus Premier Individual - Preferred Choice Plan","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network is not selected","Yes",,,,,"63366IA0020003-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","42%","58%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010003","Delta Dental Premier Plan A-L","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network dentist is not selected.","Yes",,,,,"63366IA0010003-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010003","BEST Dental Advantage - Gold","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"71051IA0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020003","BESTOne Dental Advantage - Gold","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"71051IA0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020003","BESTOne Dental Advantage - Gold","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"71051IA0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010003","BEST Dental Advantage - Gold","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Advantage_Plan_(Gold).pdf",,"71051IA0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010004","BEST Dental Plus - Gold","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Gold).pdf",,"71051IA0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020004","BESTOne Dental Plus - Gold","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"71051IA0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010004","BEST Dental Plus - Gold","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Gold).pdf",,"71051IA0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020004","BESTOne Dental Plus - Gold","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"71051IA0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010004","Delta Dental Premier Plan B-H","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network dentist is not selected.","Yes",,,,,"63366IA0010004-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-01","Standard Silver On Exchange Plan","70.30%","0.702598571777344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-03","Limited Cost Sharing Plan Variation","70.30%","0.702598571777344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-04","73% AV Level Silver Plan",,"0.737065613269806","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-05","87% AV Level Silver Plan",,"0.874881386756897","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$675","$1,350","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IA","52391","SERFF","1","2013-08-01 21:15:43","1","52391","IA","SHOP (Small Group)","Yes","47-0098400","52391IA0030002","EHB High Passive","52391IA003",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.64",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"52391IA0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","52391","SERFF","1","2013-08-01 21:15:43","1","52391","IA","SHOP (Small Group)","Yes","47-0098400","52391IA0030001","EHB Low Passive","52391IA003",,"IAN001","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.24",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"52391IA0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","57646","SERFF","1","2013-08-01 21:15:43","1","57646","IA","SHOP (Small Group)","Yes","35-0472300","57646IA0010001","DentalConnect�","57646IA001",,"IAN001","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"57646IA0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","57646","SERFF","1","2013-08-01 21:15:43","1","57646","IA","SHOP (Small Group)","Yes","35-0472300","57646IA0010002","DentalConnect�","57646IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"57646IA0010002-00","Standard Low Off Exchange Plan","71.66%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","57646","SERFF","1","2013-08-01 21:15:43","2","57646","IA","SHOP (Small Group)","Yes","35-0472300","57646IA0010003","DentalConnect�","57646IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"57646IA0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080006","CoOportunity Premier HSA Silver","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080006-00","Standard Silver Off Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $2000 - 20%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070005-00","Standard Silver Off Exchange Plan",,"0.719719231128693","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-03","Limited Cost Sharing Plan Variation",,"0.685413300991058","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070005","Silver $2000 - 20%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070005-01","Standard Silver On Exchange Plan",,"0.719719231128693","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070008-00","Standard Silver Off Exchange Plan",,"0.686079859733582","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-04","73% AV Level Silver Plan",,"0.729489862918854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$15,000","$30,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-05","87% AV Level Silver Plan",,"0.864616453647614","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070008","Silver $2000 - 0%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070008-01","Standard Silver On Exchange Plan",,"0.686079859733582","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070013","Gold $2000 - 0%  Expanded","27651IA007",,"IAN002","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070013-00","Standard Gold Off Exchange Plan",,"0.817291140556335","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","Individual","No","39-1807071","27651IA0050007","Silver $2500 - 20%","27651IA005",,"IAN003","IAS001","IAF011","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8O&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050007-06","94% AV Level Silver Plan",,"0.938193678855896","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070013","Gold $2000 - 0%  Expanded","27651IA007",,"IAN002","IAS001","IAF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8C&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070013-01","Standard Gold On Exchange Plan",,"0.817291140556335","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070015","Silver $2000 - 20% Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070015-00","Standard Silver Off Exchange Plan",,"0.719719231128693","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070015","Silver $2000 - 20% Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8E&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070015-01","Standard Silver On Exchange Plan",,"0.719719231128693","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070018","Silver $2000 Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070018-00","Standard Silver Off Exchange Plan",,"0.686079859733582","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","3","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070018","Silver $2000 Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8H&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070018-01","Standard Silver On Exchange Plan",,"0.686079859733582","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050008-00","Standard Bronze Off Exchange Plan",,"0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $3500 - 30%","27651IA007",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070009-00","Standard Bronze Off Exchange Plan",,"0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050008-01","Standard Bronze On Exchange Plan",,"0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070009","Bronze $3500 - 30%","27651IA007",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070009-01","Standard Bronze On Exchange Plan",,"0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $6350 - 0%","27651IA007",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070010-00","Standard Bronze Off Exchange Plan",,"0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070010","Bronze $6350 - 0%","27651IA007",,"IAN001","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070010-01","Standard Bronze On Exchange Plan",,"0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $5500 - 20%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070017","Silver - 50% Expanded","27651IA007",,"IAN002","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070017-01","Standard Silver On Exchange Plan",,"0.712445914745331","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $5500 - 20%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050010-03","Limited Cost Sharing Plan Variation",,"0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","6","27651","IA","Individual","No","39-1807071","27651IA0050014","Catastrophic $6,350 - 0%","27651IA005",,"IAN003","IAS001","IAF008","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050014-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","6","27651","IA","Individual","No","39-1807071","27651IA0050014","Catastrophic $6,350 - 0%","27651IA005",,"IAN003","IAS001","IAF008","New","POS","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=CT&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0010001","Guardian Pediatric Advantage","50730IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0010001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0010001","Guardian Pediatric Advantage","50730IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0010001-01","Standard High On Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0020001","Guardian Pediatric Essentials","50730IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0020001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","1","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0020001","Guardian Pediatric Essentials","50730IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0020001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","50730","SERFF","4","2013-11-27 09:24:34","2","50730","IA","SHOP (Small Group)","Yes","13-5123390","50730IA0030001","Guardian Family Advantage Plus","50730IA003",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"50730IA0030001-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050008","Bronze $2500 - 50%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8U&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050008-03","Limited Cost Sharing Plan Variation",,"0.615333676338196","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable","$2,500","$5,000","50%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070019","Bronze $3500 - 30% Expanded","27651IA007",,"IAN002","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070019-00","Standard Bronze Off Exchange Plan",,"0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $3500 - 30%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050009-00","Standard Bronze Off Exchange Plan",,"0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $3500 - 30%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050009-01","Standard Bronze On Exchange Plan",,"0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070019","Bronze $3500 - 30% Expanded","27651IA007",,"IAN002","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8I&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070019-01","Standard Bronze On Exchange Plan",,"0.608460307121277","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $3500 - 30%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070020","Bronze $6350 - 0%  Expanded","27651IA007",,"IAN002","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070020-00","Standard Bronze Off Exchange Plan",,"0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070020","Bronze $6350 - 0%  Expanded","27651IA007",,"IAN002","IAS001","IAF004","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8J&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070020-01","Standard Bronze On Exchange Plan",,"0.606137454509735","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","4","27651","IA","Individual","No","39-1807071","27651IA0050009","Bronze $3500 - 30%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8R&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050009-03","Limited Cost Sharing Plan Variation",,"0.611142992973328","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","Individual","No","39-1807071","27651IA0050010","Bronze $5500 - 20%","27651IA005",,"IAN003","IAS001","IAF012","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Goes to Level 2 benefit unless Urgent/Emergent, Rx not covered OON","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8T&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0050010-00","Standard Bronze Off Exchange Plan",,"0.600705564022064","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable","$5,500","$11,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","27651","SERFF","5","2013-11-27 09:24:34","5","27651","IA","SHOP (Small Group)","No","39-1807071","27651IA0070007","Silver - 50%","27651IA007",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent/Emergent","Yes","Urgent/Emergent","No","http://secure.gundersenhealthplan.org/SBC/pdf/print/?benefit_pkg_id=8G&eff_date=01/01/2014&state=IA",,,"http://www.gundersenhealthplan.org/QHPformulary","27651IA0070007-00","Standard Silver Off Exchange Plan",,"0.712445914745331","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","33%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020002","BESTOne Child Dental","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plan.pdf",,"71051IA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010002","BEST Life Child Dental","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plan.pdf",,"71051IA0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020002","BESTOne Child Dental","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plan.pdf",,"71051IA0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010001","Delta Dental Premier Plan A-LM","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network dentist is not selected.","Yes","www.deltadentalia.com/mp/shop-alm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010001-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","Individual","Yes","42-0959302","63366IA0020001","Delta Dental PPO Plus Premier Individual - Preferred Choice Plan","63366IA002","7790788922","IAN002","IAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network is not selected","Yes","www.deltadentalia.com/mp/individual/preferred","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/individual/brochure",,"63366IA0020001-01","Standard High On Exchange Plan","85.20%",,,,"Yes","42%","58%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050008","CoOportunity Premier Catastrophic","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050006","CoOportunity Premier Bronze","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050006-00","Standard Bronze Off Exchange Plan","60.10%","0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010009","Delta Dental Premier Plan B-HC","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010009-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010010","Delta Dental Premier Plan C-HC","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010010-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","3","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010011","Delta Dental PPO Plus Premier Plan B-HM","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes","www.deltadentalia.com/mp/shop-ppobhm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010011-01","Standard High On Exchange Plan","85.20%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","3","63366","IA","Individual","Yes","42-0959302","63366IA0020005","Delta Dental PPO Plus Premier Individual - Comprehensive Plan","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.65",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network is not selected","Yes",,,,,"63366IA0020005-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","52%","48%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060002","CoOportunity Choice UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,"$91.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060002-03","Limited Cost Sharing Plan Variation",,"0.782106161117554","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-00","Standard Silver Off Exchange Plan","69.80%","0.698559939861298","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-01","Standard Silver On Exchange Plan","69.80%","0.698559939861298","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-03","Limited Cost Sharing Plan Variation","69.80%","0.698559939861298","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-04","73% AV Level Silver Plan","74.00%","0.742403209209442","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,200","$8,400","$5,200","$10,400","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","30%","$5,200","$10,400","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-05","87% AV Level Silver Plan","87.30%","0.874521315097809","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,200","$2,400","$2,250","$4,500","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","20%","$1,200","$2,400","40%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-06","94% AV Level Silver Plan",,"0.940450727939606","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$450","$900",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$225","$450","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060001","CoOportunity Choice UI Health Alliance Platinum","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,"$46.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060001-00","Standard Platinum Off Exchange Plan",,"0.881629228591919","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,500","$3,000","30%","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090001","CoOportunity Choice UI Health Alliance Platinum","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090001-00","Standard Platinum Off Exchange Plan",,"0.881629228591919","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,500","$3,000","30%","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","1","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010005","Delta Dental Premier Plan C-H","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network dentist is not selected.","Yes",,,,,"63366IA0010005-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-03","Limited Cost Sharing Plan Variation",,"0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070001","CoOportunity Preferred UI Health Alliance Platinum","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,"$41.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100002","CoOportunity Preferred UI Health Alliance Gold","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100002-00","Standard Gold Off Exchange Plan",,"0.793535530567169","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100002","CoOportunity Preferred UI Health Alliance Gold","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100002-01","Standard Gold On Exchange Plan",,"0.793535530567169","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070001","CoOportunity Preferred UI Health Alliance Platinum","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,"$41.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070001-03","Limited Cost Sharing Plan Variation",,"0.892769396305084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070002","CoOportunity Preferred UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,"$86.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070002-00","Standard Gold Off Exchange Plan",,"0.793535530567169","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100003","CoOportunity Preferred UI Health Alliance Silver","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100003-00","Standard Silver Off Exchange Plan",,"0.713157653808594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070002","CoOportunity Preferred UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,"$86.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070002-01","Standard Gold On Exchange Plan",,"0.793535530567169","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100003","CoOportunity Preferred UI Health Alliance Silver","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100003-01","Standard Silver On Exchange Plan",,"0.713157653808594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070002","CoOportunity Preferred UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,"$86.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010006","Delta Dental Premier Plan A-LCM","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-only",,,,"$28.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes","www.deltadentalia.com/mp/shop-alcm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010006-01","Standard Low On Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","Individual","Yes","42-0959302","63366IA0020002","Delta Dental PPO Plus Premier Individual - Preventive Plan","63366IA002","7790788922","IAN002","IAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.79",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network is not selected","Yes","www.deltadentalia.com/mp/individual/preventive","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/individual/brochure",,"63366IA0020002-01","Standard Low On Exchange Plan","70.30%",,,,"Yes","33%","67%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010007","Delta Dental Premier Plan B-HCM","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-only",,,,"$31.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes","www.deltadentalia.com/mp/shop-bhcm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010007-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","Individual","Yes","42-0959302","63366IA0020004","Delta Dental PPO Plus Premier Individual - Preventive Plan","63366IA002","7790788922","IAN002","IAS001",,"Existing","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.79",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbursement if an in-network is not selected","Yes",,,,,"63366IA0020004-00","Standard Low Off Exchange Plan","70.30%",,,,"Yes","33%","67%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","2","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010008","Delta Dental Premier Plan A-LC","63366IA001","7790788922","IAN001","IAS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-only",,,,"$28.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010008-00","Standard Low Off Exchange Plan","70.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010004","BEST Dental Plus - High","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Plus_Plan_(Gold).pdf",,"17859ID0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","Individual","Yes","95-6042390","17859ID0020004","BESTOne Dental Plus - High","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"17859ID0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","Individual","Yes","95-6042390","17859ID0020005","BESTOne Dental Plus - Low","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"17859ID0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010005","BEST Dental Plus - Low","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Plus_Plan_(Silver).pdf",,"17859ID0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010005","BEST Dental Plus - Low","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Plus_Plan_(Silver).pdf",,"17859ID0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","Individual","Yes","95-6042390","17859ID0020005","BESTOne Dental Plus - Low","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"17859ID0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010006","BEST Dental Basic - Low","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Basic_Plan_(Silver).pdf",,"17859ID0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","Individual","Yes","95-6042390","17859ID0020006","BESTOne Dental Basic - Low","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"17859ID0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010006","BEST Dental Basic - Low","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Basic_Plan_(Silver).pdf",,"17859ID0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010004","Avera $750 / 30% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12147/Avera-750-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010004-00","Standard Gold Off Exchange Plan",,"0.788623571395874","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$750","$1,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010004","Avera $750 / 30% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12147/Avera-750-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010004-01","Standard Gold On Exchange Plan",,"0.788623571395874","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$750","$1,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080005","CoOportunity Premier HSA Gold","71268IA008",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080005-00","Standard Gold Off Exchange Plan","78.50%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050003","CoOportunity Premier HSA Gold","71268IA005",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$87.93","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050003-00","Standard Gold Off Exchange Plan","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080006","CoOportunity Premier HSA Silver","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080006-01","Standard Silver On Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050003","CoOportunity Premier HSA Gold","71268IA005",,"IAN001","IAS001","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$87.93","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050003-03","Limited Cost Sharing Plan Variation","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080007","CoOportunity Premier HSA Bronze","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080007-00","Standard Bronze Off Exchange Plan","60.60%","0.611596345901489","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-00","Standard Silver Off Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050007","CoOportunity Premier HSA Bronze","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$186.77","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050007-03","Limited Cost Sharing Plan Variation","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050008","CoOportunity Premier Catastrophic","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050006","CoOportunity Premier Bronze","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050006-01","Standard Bronze On Exchange Plan","60.10%","0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050006","CoOportunity Premier Bronze","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","7","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010006","Avera $2,000 / $6,000 Out-of-Pocket","74980IA001","7942203176","IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12152/Avera-2000-6000-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010006-01","Standard Silver On Exchange Plan",,"0.696188032627106","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","8","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010007","Avera $2,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12155/Avera-2000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010007-00","Standard Silver Off Exchange Plan",,"0.71366024017334","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170005","BrightIdea Balance Bronze 6350","60597ID017",,"IDN002","IDS002","IDF002","New","HMO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967608&libID=4294967608","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170005-00","Standard Bronze Off Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190014","SmartHealth Balance Gold 500","60597ID019",,"IDN001","IDS003","IDF027","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967488&libID=4294967488","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190014-01","Standard Gold On Exchange Plan",,"0.78199565410614","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$40","$500","$1,700","$200","$40","9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060004","CoOportunity Choice UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$131.73","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060004-06","94% AV Level Silver Plan","94.80%","0.948449909687042","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$200","$400","$1,000","$2,000","$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%","$500","$1,000","30%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070001","CoOportunity Preferred UI Health Alliance Platinum","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,"$41.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070001-00","Standard Platinum Off Exchange Plan",,"0.892769396305084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100001","CoOportunity Preferred UI Health Alliance Platinum","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100001-00","Standard Platinum Off Exchange Plan",,"0.892769396305084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100001","CoOportunity Preferred UI Health Alliance Platinum","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100001-01","Standard Platinum On Exchange Plan",,"0.892769396305084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070001","CoOportunity Preferred UI Health Alliance Platinum","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Platinum","No","Both","No","No",,,"$41.67","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070001-01","Standard Platinum On Exchange Plan",,"0.892769396305084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","3","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010012","Delta Dental PPO Plus Premier Plan A-L","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010012-00","Standard Low Off Exchange Plan","70.30%",,,,"Yes","50%","50%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","3","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010013","Delta Dental PPO Plus Premier Plan B-H","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010013-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","3","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010014","Delta Dental PPO Plus Premier Plan C-H","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010014-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","54%","46%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","4","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010015","Delta Dental PPO Plus Premier Plan B-HCM","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes","www.deltadentalia.com/mp/shop-ppobhcm","https://saml.deltadentalia.com/sp/ACS.saml2","www.deltadentalia.com/mp/smallgroup/brochure",,"63366IA0010015-01","Standard High On Exchange Plan","85.20%",,,,"Yes","50%","50%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","4","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010016","Delta Dental PPO Plus Premier Plan A-LC","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010016-00","Standard Low Off Exchange Plan","70.30%",,,,"Yes","54%","46%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","4","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010017","Delta Dental PPO Plus Premier Plan B-HC","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010017-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","50%","50%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","4","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010018","Delta Dental PPO Plus Premier Plan C-HC","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010018-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","67%","33%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-03","Limited Cost Sharing Plan Variation",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060003","CoOportunity Choice HSA UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$88.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060003-01","Standard Gold On Exchange Plan","78.70%","0.789264798164368","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$4,000","$8,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%","$2,800","$5,600","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090006","CoOportunity Choice HSA UI Health Alliance Silver","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090006-00","Standard Silver Off Exchange Plan","68.20%","0.685897886753082","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,350","$12,700","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060003","CoOportunity Choice HSA UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$88.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090006","CoOportunity Choice HSA UI Health Alliance Silver","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090006-01","Standard Silver On Exchange Plan","68.20%","0.685897886753082","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,350","$12,700","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","5","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010019","Delta Dental PPO Plus Premier Small Group Voluntary - Comprehensive Plan","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010019-00","Standard High Off Exchange Plan","85.20%",,,,"Yes","48%","52%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,"$25","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","6","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010020","Delta Dental PPO Plus Premier Small Group Voluntary - Preventive Plan","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010020-00","Standard Low Off Exchange Plan","70.30%",,,,"Yes","29%","71%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","63366","SERFF","9","2014-03-18 09:48:59","7","63366","IA","SHOP (Small Group)","Yes","42-0959302","63366IA0010021","Delta Dental PPO Plus Premier Small Group Voluntary - Catastrophic Plan","63366IA001","7790788922","IAN002","IAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Claims can be submitted for reimbursement","Yes","Claims can be submitted for reimbusement if an in-network detntist is not selected","Yes",,,,,"63366IA0010021-00","Standard Low Off Exchange Plan","70.30%",,,,"Yes","61%","39%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,"$75","Not Applicable",,"$225","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020001","BESTOne Child Dental Plus","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plus_Plan.pdf",,"71051IA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010001","BEST Life Child Dental Plus","71051IA001",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Child_Dental_Plus_Plan.pdf",,"71051IA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020001","BESTOne Child Dental Plus","71051IA002",,"IAN001","IAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.87",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Child_Dental_Plus_Plan.pdf",,"71051IA0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010005","BEST Dental Plus - Silver","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Silver).pdf",,"71051IA0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"71051IA0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020005","BESTOne Dental Plus - Silver","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"71051IA0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","SHOP (Small Group)","Yes","95-6042390","71051IA0010005","BEST Dental Plus - Silver","71051IA001",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BEST_Dental_Plus_Plan_(Silver).pdf",,"71051IA0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","IA","71051","SERFF","4","2014-01-14 14:20:21","1","71051","IA","Individual","Yes","95-6042390","71051IA0020006","BESTOne Dental Basic - Silver","71051IA002",,"IAN001","IAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/IA/pdf/IA_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"71051IA0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050001","CoOportunity Premier Platinum","71268IA005",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,"$44.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080002","CoOportunity Premier Gold","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080002-01","Standard Gold On Exchange Plan",,"0.782301127910614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050001","CoOportunity Premier Platinum","71268IA005",,"IAN001","IAS001","IAF003","New","PPO","Platinum","No","Both","No","No",,,"$44.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050001-03","Limited Cost Sharing Plan Variation",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050002","CoOportunity Premier Gold","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Gold","Yes","Both","No","No",,,"$91.68","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050002-00","Standard Gold Off Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080003","CoOportunity Premier Silver","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080003-00","Standard Silver Off Exchange Plan",,"0.719447195529938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050002","CoOportunity Premier Gold","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Gold","Yes","Both","No","No",,,"$91.68","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050002-01","Standard Gold On Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080003","CoOportunity Premier Silver","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080003-01","Standard Silver On Exchange Plan",,"0.719447195529938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050002","CoOportunity Premier Gold","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Gold","Yes","Both","No","No",,,"$91.68","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050002","CoOportunity Premier Gold","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Gold","Yes","Both","No","No",,,"$91.68","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050002-03","Limited Cost Sharing Plan Variation","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-00","Standard Silver Off Exchange Plan",,"0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-01","Standard Silver On Exchange Plan",,"0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","1","71268","IA","Individual","No","45-3468530","71268IA0050004","CoOportunity Premier Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","No","Both","No","No",,,"$70.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070002","CoOportunity Preferred UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","No","Both","No","No",,,"$86.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070002-03","Limited Cost Sharing Plan Variation",,"0.793535530567169","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-00","Standard Silver Off Exchange Plan","70.30%","0.702598571777344","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090001","CoOportunity Choice UI Health Alliance Platinum","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090001-01","Standard Platinum On Exchange Plan",,"0.881629228591919","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,500","$3,000","30%","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060001","CoOportunity Choice UI Health Alliance Platinum","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,"$46.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060001-01","Standard Platinum On Exchange Plan",,"0.881629228591919","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,500","$3,000","30%","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090002","CoOportunity Choice UI Health Alliance Gold","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090002-00","Standard Gold Off Exchange Plan",,"0.782106161117554","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060001","CoOportunity Choice UI Health Alliance Platinum","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,"$46.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","Individual","No","45-3468530","71268IA0070007","CoOportunity Preferred UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070007-03","Limited Cost Sharing Plan Variation","59.90%","0.608155488967896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020001","Avera MyPlan $1,500 / 20% Coinsurance","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12137/Avera-MyPlan-1500-20-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020001-00","Standard Gold Off Exchange Plan",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010010","SelectHealth Preference Bronze 5000","26002ID001",,"IDN001","IDS002","IDF008","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030002","SelectHealth Signature $250 w/office ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030002-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030002-00","Standard Gold Off Exchange Plan",,"0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030003","SelectHealth Signature $250 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030003-00","Standard Gold Off Exchange Plan",,"0.81722491979599","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030003","SelectHealth Signature $250 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030003-01","Standard Gold On Exchange Plan",,"0.81722491979599","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090002","CoOportunity Choice UI Health Alliance Gold","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090002-01","Standard Gold On Exchange Plan",,"0.782106161117554","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060001","CoOportunity Choice UI Health Alliance Platinum","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Platinum","No","Both","No","No",,,"$46.35","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060001-03","Limited Cost Sharing Plan Variation",,"0.881629228591919","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$3,000","$6,000","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$1,500","$3,000","30%","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060002","CoOportunity Choice UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,"$91.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060002-00","Standard Gold Off Exchange Plan",,"0.782106161117554","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090003","CoOportunity Choice UI Health Alliance Silver","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090003-00","Standard Silver Off Exchange Plan",,"0.708509683609009","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060002","CoOportunity Choice UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,"$91.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060002-01","Standard Gold On Exchange Plan",,"0.782106161117554","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$6,000","$12,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090003","CoOportunity Choice UI Health Alliance Silver","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090003-01","Standard Silver On Exchange Plan",,"0.708509683609009","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","2","71268","IA","Individual","No","45-3468530","71268IA0060002","CoOportunity Choice UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Gold","No","Both","No","No",,,"$91.26","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-04","73% AV Level Silver Plan","74.00%","0.740052402019501","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-05","87% AV Level Silver Plan","88.00%","0.880917131900787","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","3","71268","IA","Individual","No","45-3468530","71268IA0070003","CoOportunity Preferred UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$65.71","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070003-06","94% AV Level Silver Plan","94.70%","0.947006225585938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-01","Standard Silver On Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080007","CoOportunity Premier HSA Bronze","71268IA008",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080007-01","Standard Bronze On Exchange Plan","60.60%","0.611596345901489","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070004","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,"$90.43","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100006","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100006-00","Standard Silver Off Exchange Plan","69.30%","0.69613254070282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100006","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100006-01","Standard Silver On Exchange Plan","69.30%","0.69613254070282","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070004","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,"$90.43","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070004-03","Limited Cost Sharing Plan Variation","78.30%","0.795270204544067","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100007","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100007-00","Standard Bronze Off Exchange Plan","61.60%","0.618221700191498","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-00","Standard Silver Off Exchange Plan","68.80%","0.683918833732605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-01","Standard Silver On Exchange Plan","68.80%","0.683918833732605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100007","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100007-01","Standard Bronze On Exchange Plan","61.60%","0.618221700191498","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-03","Limited Cost Sharing Plan Variation","68.80%","0.683918833732605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080004","CoOportunity Premier Bronze","71268IA008",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080004-00","Standard Bronze Off Exchange Plan","61.50%","0.636123239994049","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0080004","CoOportunity Premier Bronze","71268IA008",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0080004-01","Standard Bronze On Exchange Plan","61.50%","0.636123239994049","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-03","Limited Cost Sharing Plan Variation","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-04","73% AV Level Silver Plan","73.90%","0.742269039154053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-05","87% AV Level Silver Plan","86.20%","0.861384749412537","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050005","CoOportunity Premier HSA Silver","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$70.54","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050005-06","94% AV Level Silver Plan","94.20%","0.943639814853668","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050007","CoOportunity Premier HSA Bronze","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$186.77","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050007-00","Standard Bronze Off Exchange Plan","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050007","CoOportunity Premier HSA Bronze","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$186.77","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050007-01","Standard Bronze On Exchange Plan","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050007","CoOportunity Premier HSA Bronze","71268IA005",,"IAN001","IAS001","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$186.77","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2","77638IA008","7659374889","IAN001","IAS001","IAF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QG/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QG/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080003-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","13"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6PA/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6PA/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","14"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6PA/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6PA/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","15"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6PK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6PK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","16"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020007","Avera MyPlan $5,000 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$145.86","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12143/Avera-MyPlan-5000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020007-00","Standard Bronze Off Exchange Plan",,"0.613580644130707","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020007","Avera MyPlan $5,000 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$145.86","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12143/Avera-MyPlan-5000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020007-01","Standard Bronze On Exchange Plan",,"0.613580644130707","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-04","73% AV Level Silver Plan","73.60%","0.729025840759277","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,400","$6,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-05","87% AV Level Silver Plan","87.30%","0.866043329238892","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070005","CoOportunity Preferred HSA UI Health Alliance Silver","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Silver","Yes","Both","No","No",,,"$70.79","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070005-06","94% AV Level Silver Plan","94.70%","0.943989336490631","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070006","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$187.22","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070006-00","Standard Bronze Off Exchange Plan","58.20%","0.596510827541351","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","4","71268","IA","Individual","No","45-3468530","71268IA0050006","CoOportunity Premier Bronze","71268IA005",,"IAN001","IAS001","IAF004","New","PPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0050006-03","Limited Cost Sharing Plan Variation","60.10%","0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090005","CoOportunity Choice HSA UI Health Alliance Gold","71268IA009",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090005-00","Standard Gold Off Exchange Plan","78.70%","0.789264798164368","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$4,000","$8,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%","$2,800","$5,600","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060003","CoOportunity Choice HSA UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$88.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060003-00","Standard Gold Off Exchange Plan","78.70%","0.789264798164368","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$4,000","$8,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%","$2,800","$5,600","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-06","94% AV Level Silver Plan","94.80%","0.948184967041016","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$300","$600","$1,500","$3,000","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","10%","$750","$1,500","30%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,"$181.84","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060007-00","Standard Bronze Off Exchange Plan","59.40%","0.610450148582459","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$6,000","$12,000","40%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,"$181.84","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060007-01","Standard Bronze On Exchange Plan","59.40%","0.6104936003685","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$6,000","$12,000","40%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,"$181.84","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"17"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-03","Limited Cost Sharing Plan Variation",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-04","73% AV Level Silver Plan",,"0.730833292007446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-05","87% AV Level Silver Plan",,"0.864668190479279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090005","CoOportunity Choice HSA UI Health Alliance Gold","71268IA009",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090005-01","Standard Gold On Exchange Plan","78.70%","0.789264798164368","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$4,000","$8,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%","$2,800","$5,600","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060003","CoOportunity Choice HSA UI Health Alliance Gold","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Gold","Yes","Both","No","No",,,"$88.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060003-03","Limited Cost Sharing Plan Variation","78.70%","0.789264798164368","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$4,000","$8,000","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%","$2,800","$5,600","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-00","Standard Silver Off Exchange Plan","68.40%","0.685892462730408","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,400","$8,800","$6,350","$12,700","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","20%","$4,400","$8,800","40%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA009",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090007-00","Standard Bronze Off Exchange Plan","59.60%","0.61515337228775","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","30%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA009",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090007-01","Standard Bronze On Exchange Plan","59.60%","0.61515337228775","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","30%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-01","Standard Silver On Exchange Plan","68.40%","0.685892462730408","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,400","$8,800","$6,350","$12,700","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","20%","$4,400","$8,800","40%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"10"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-03","Limited Cost Sharing Plan Variation","68.40%","0.685892462730408","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$4,400","$8,800","$6,350","$12,700","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","20%","$4,400","$8,800","40%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-04","73% AV Level Silver Plan","73.40%","0.734305918216705","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,200","$6,400","$5,200","$10,400","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%","$3,200","$6,400","40%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060005","CoOportunity Choice HSA UI Health Alliance Silver","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Silver","Yes","Both","No","No",,,"$73.33","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060005-05","87% AV Level Silver Plan","87.60%","0.874162316322327","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,250","$4,500","$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$2,250","$4,500","30%","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060007","CoOportunity Choice HSA UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF002","New","PPO","Bronze","Yes","Both","No","No",,,"$181.84","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060007-03","Limited Cost Sharing Plan Variation","59.40%","0.6104936003685","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$6,000","$12,000","40%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060008","CoOportunity Choice UI Health Alliance Catastrophic","71268IA006",,"IAN002","IAS002","IAF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","5","71268","IA","Individual","No","45-3468530","71268IA0060008","CoOportunity Choice UI Health Alliance Catastrophic","71268IA006",,"IAN002","IAS002","IAF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070004","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,"$90.43","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070004-00","Standard Gold Off Exchange Plan","78.30%","0.795270204544067","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100005","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100005-00","Standard Gold Off Exchange Plan","78.30%","0.795270204544067","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100005","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100005-01","Standard Gold On Exchange Plan","78.30%","0.795270204544067","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070004","CoOportunity Preferred HSA UI Health Alliance Gold","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Gold","Yes","Both","No","No",,,"$90.43","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070004-01","Standard Gold On Exchange Plan","78.30%","0.795270204544067","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070006","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$187.22","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070006-01","Standard Bronze On Exchange Plan","58.20%","0.596510827541351","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070006","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$187.22","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070006","CoOportunity Preferred HSA UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$187.22","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070006-03","Limited Cost Sharing Plan Variation","58.20%","0.596510827541351","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070008","CoOportunity Preferred UI Health Alliance Catastrophic","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","6","71268","IA","Individual","No","45-3468530","71268IA0070008","CoOportunity Preferred UI Health Alliance Catastrophic","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090004","CoOportunity Choice UI Health Alliance Bronze","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090004-00","Standard Bronze Off Exchange Plan","59.40%","0.644014060497284","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","Individual","No","45-3468530","71268IA0060006","CoOportunity Choice UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$170.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060006-00","Standard Bronze Off Exchange Plan","58.70%","0.625662267208099","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","Individual","No","45-3468530","71268IA0060006","CoOportunity Choice UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$170.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060006-01","Standard Bronze On Exchange Plan","58.70%","0.625662267208099","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0090004","CoOportunity Choice UI Health Alliance Bronze","71268IA009",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0090004-01","Standard Bronze On Exchange Plan","59.40%","0.644014060497284","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","Individual","No","45-3468530","71268IA0060006","CoOportunity Choice UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$170.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","7","71268","IA","Individual","No","45-3468530","71268IA0060006","CoOportunity Choice UI Health Alliance Bronze","71268IA006",,"IAN002","IAS002","IAF001","New","PPO","Bronze","Yes","Both","No","No",,,"$170.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Coverage for emergency services only","Yes","Out of Network benefits will be applied","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0060006-03","Limited Cost Sharing Plan Variation","58.70%","0.625662267208099","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$26,000","$52,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%","$6,350","$12,700","0%","$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","Individual","No","45-3468530","71268IA0070007","CoOportunity Preferred UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070007-00","Standard Bronze Off Exchange Plan","59.90%","0.608155488967896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100004","CoOportunity Preferred UI Health Alliance Bronze","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100004-00","Standard Bronze Off Exchange Plan","59.40%","0.626286268234253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","SHOP (Small Group)","No","45-3468530","71268IA0100004","CoOportunity Preferred UI Health Alliance Bronze","71268IA010",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","71268IA0100004-01","Standard Bronze On Exchange Plan","59.40%","0.626286268234253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","Individual","No","45-3468530","71268IA0070007","CoOportunity Preferred UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070007-01","Standard Bronze On Exchange Plan","59.90%","0.608155488967896","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","71268","SERFF","8","2014-01-23 12:49:01","8","71268","IA","Individual","No","45-3468530","71268IA0070007","CoOportunity Preferred UI Health Alliance Bronze","71268IA007",,"IAN003","IAS003","IAF005","New","EPO","Bronze","Yes","Both","No","No",,,"$179.60","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"No",,"No",,"No","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","71268IA0070007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020010","Avera MyPlan $6,000 / 30% coinsurance","74980IA002",,"IAN001","IAS001","IAF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$148.34","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12144/Avera-MyPlan-6000-30-coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020010-03","Limited Cost Sharing Plan Variation",,"0.602429270744324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010002","Avera $1,000 / 20% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12077/Avera-1000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010002-00","Standard Gold Off Exchange Plan",,"0.788114190101624","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","28"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-03","Limited Cost Sharing Plan Variation","70.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","29"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-04","73% AV Level Silver Plan","72.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$400","$600","$200","$80","30"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$10","$1,000","$200","$400","$600","$200","$80","31"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020001","Avera MyPlan $1,500 / 20% Coinsurance","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12137/Avera-MyPlan-1500-20-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020001-03","Limited Cost Sharing Plan Variation",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-00","Standard Silver Off Exchange Plan",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010001","SelectHealth Preference Gold 250","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010001-01","Standard Gold On Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030001","SelectHealth Signature $250","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030001-01","Standard Gold On Exchange Plan",,"0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060001","Simplicity $500","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060001-00","Standard Platinum Off Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","4","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0060001","Guardian Family Essentials","10204ID006",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0060001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","1","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010001","BEST Life Child Dental Plus","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Child_Dental_Plus_Plan.pdf",,"17859ID0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","1","17859","ID","Individual","Yes","95-6042390","17859ID0020001","BESTOne Child Dental Plus","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Child_Dental_Plus_Plan.pdf",,"17859ID0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","Individual","Yes","95-6042390","17859ID0020003","BESTOne Dental Advantage - High","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"17859ID0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010003","BEST Dental Advantage - High","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Advantage_Plan_(Gold).pdf",,"17859ID0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","Individual","Yes","95-6042390","17859ID0020003","BESTOne Dental Advantage - High","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"17859ID0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","4","17859","ID","Individual","Yes","95-6042390","17859ID0020006","BESTOne Dental Basic - Low","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"17859ID0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","1","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010001","BEST Life Child Dental Plus","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Child_Dental_Plus_Plan.pdf",,"17859ID0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","1","17859","ID","Individual","Yes","95-6042390","17859ID0020001","BESTOne Child Dental Plus","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Child_Dental_Plus_Plan.pdf",,"17859ID0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","2","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010002","BEST Life Child Dental","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Child_Dental_Plan.pdf",,"17859ID0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","2","17859","ID","Individual","Yes","95-6042390","17859ID0020002","BESTOne Child Dental","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Child_Dental_Plan.pdf",,"17859ID0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","2","17859","ID","Individual","Yes","95-6042390","17859ID0020002","BESTOne Child Dental","17859ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$32.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Child_Dental_Plan.pdf",,"17859ID0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","2","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010002","BEST Life Child Dental","17859ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Child_Dental_Plan.pdf",,"17859ID0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020001","Avera MyPlan $1,500 / 20% Coinsurance","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12137/Avera-MyPlan-1500-20-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010010","Avera $250 / 10% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12146/Avera-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010010-01","Standard Platinum On Exchange Plan",,"0.880801022052765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020002","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12134/Avera-MyPlan-150020-Coinsurance-with-Pediatric-Dental-Coverage-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020002-01","Standard Gold On Exchange Plan",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020002","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12134/Avera-MyPlan-150020-Coinsurance-with-Pediatric-Dental-Coverage-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010008","Avera $2,000 / 25% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12081/Avera-2000-25-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010008-00","Standard Silver Off Exchange Plan",,"0.705963373184204","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010008","Avera $2,000 / 25% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF007","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12081/Avera-2000-25-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010008-01","Standard Silver On Exchange Plan",,"0.705963373184204","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-03","Limited Cost Sharing Plan Variation",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010003","BEST Dental Advantage - High","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Advantage_Plan_(Gold).pdf",,"17859ID0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","SHOP (Small Group)","Yes","95-6042390","17859ID0010004","BEST Dental Plus - High","17859ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BEST_Dental_Plus_Plan_(Gold).pdf",,"17859ID0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","17859","SERFF","4","2014-01-24 09:49:15","3","17859","ID","Individual","Yes","95-6042390","17859ID0020004","BESTOne Dental Plus - High","17859ID002",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.71",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/ID/pdf/ID_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"17859ID0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$1,000","Not Applicable",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020001","Avera MyPlan $1,500 / 20% Coinsurance","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12137/Avera-MyPlan-1500-20-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020001-01","Standard Gold On Exchange Plan",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010010","Avera $250 / 10% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12146/Avera-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010010-00","Standard Platinum Off Exchange Plan",,"0.880801022052765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020007","Avera MyPlan $5,000 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$145.86","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12143/Avera-MyPlan-5000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020007-03","Limited Cost Sharing Plan Variation",,"0.613580644130707","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020010","Avera MyPlan $6,000 / 30% coinsurance","74980IA002",,"IAN001","IAS001","IAF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$148.34","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12144/Avera-MyPlan-6000-30-coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020010-00","Standard Bronze Off Exchange Plan",,"0.602429270744324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020010","Avera MyPlan $6,000 / 30% coinsurance","74980IA002",,"IAN001","IAS001","IAF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$148.34","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12144/Avera-MyPlan-6000-30-coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020010-01","Standard Bronze On Exchange Plan",,"0.602429270744324","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020010","Avera MyPlan $6,000 / 30% coinsurance","74980IA002",,"IAN001","IAS001","IAF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$148.34","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12144/Avera-MyPlan-6000-30-coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020002","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12134/Avera-MyPlan-150020-Coinsurance-with-Pediatric-Dental-Coverage-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020002-03","Limited Cost Sharing Plan Variation",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-00","Standard Silver Off Exchange Plan",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-01","Standard Silver On Exchange Plan",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-01","Standard Silver On Exchange Plan",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-03","Limited Cost Sharing Plan Variation",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-04","73% AV Level Silver Plan",,"0.72654926776886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-05","87% AV Level Silver Plan",,"0.861532390117645","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020004","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12141/Avera-MyPlan-2500-6350-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020004-06","94% AV Level Silver Plan",,"0.938692569732666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-00","Standard Silver Off Exchange Plan",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-01","Standard Silver On Exchange Plan",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020008","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.42","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12139/Avera-MyPlan-25005500-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020008-06","94% AV Level Silver Plan",,"0.938167095184326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-00","Standard Silver Off Exchange Plan",,"0.699911177158356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-01","Standard Silver On Exchange Plan",,"0.699911177158356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-03","Limited Cost Sharing Plan Variation",,"0.699911177158356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-04","73% AV Level Silver Plan",,"0.727409780025482","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-05","87% AV Level Silver Plan",,"0.863068342208862","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","1","74980","IA","Individual","No","46-0451539","74980IA0020011","Avera MyPlan $1,500 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$114.46","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12138/Avera-MyPlan-1500-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020011-06","94% AV Level Silver Plan",,"0.930014252662659","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010009","Avera $2,000 / $4,000 Out-of-Pocket","74980IA001","7942203176","IAN001","IAS001","IAF008","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12078/Avera-2000-4000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010009-00","Standard Silver Off Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010009","Avera $2,000 / $4,000 Out-of-Pocket","74980IA001","7942203176","IAN001","IAS001","IAF008","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12078/Avera-2000-4000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010009-01","Standard Silver On Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","2","74980","IA","Individual","No","46-0451539","74980IA0020006","Avera MyPlan H.S.A. $3,500","74980IA002",,"IAN001","IAS001","IAF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$112.02","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12142/Avera-MyPlan-Health-Savings-Account-HSA-3500-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020006-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","Individual","No","46-0451539","74980IA0020012","Avera MyPlan $250 / 10% Coinsurance","74980IA002",,"IAN001","IAS001","IAF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$38.61","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12133/Avera-MyPlan-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020012-00","Standard Platinum Off Exchange Plan",,"0.880801022052765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010001","Avera $2,000 / 50% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF001","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12150/Avera-2000-50-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010001-00","Standard Bronze Off Exchange Plan",,"0.619092643260956","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","Individual","No","46-0451539","74980IA0020012","Avera MyPlan $250 / 10% Coinsurance","74980IA002",,"IAN001","IAS001","IAF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$38.61","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12133/Avera-MyPlan-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020012-01","Standard Platinum On Exchange Plan",,"0.880801022052765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010001","Avera $2,000 / 50% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF001","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12150/Avera-2000-50-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010001-01","Standard Bronze On Exchange Plan",,"0.619092643260956","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","Individual","No","46-0451539","74980IA0020012","Avera MyPlan $250 / 10% Coinsurance","74980IA002",,"IAN001","IAS001","IAF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$38.61","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12133/Avera-MyPlan-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","3","74980","IA","Individual","No","46-0451539","74980IA0020012","Avera MyPlan $250 / 10% Coinsurance","74980IA002",,"IAN001","IAS001","IAF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$38.61","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12133/Avera-MyPlan-250-10-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020012-03","Limited Cost Sharing Plan Variation",,"0.880801022052765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010005","Avera $2,000 / 20% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12080/Avera-2000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010005-00","Standard Silver Off Exchange Plan",,"0.70502108335495","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","8","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010007","Avera $2,000 / 30% Coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF006","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12155/Avera-2000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010007-01","Standard Silver On Exchange Plan",,"0.71366024017334","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160002","Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3","77638IA016","7659374889","IAN001","IAS001","IAF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/22V/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/22V/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160002-00","Standard Silver Off Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,400","$200","$1,500","$600","$200","$80","4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160002","Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3","77638IA016","7659374889","IAN001","IAS001","IAF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/22V/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/22V/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160002-01","Standard Silver On Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,400","$200","$1,500","$600","$200","$80","5"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77638IA016","7659374889","IAN001","IAS001","IAF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/23S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/23S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160001-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","6"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77638IA016","7659374889","IAN001","IAS001","IAF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/23S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/23S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160001-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","7"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77638IA007","7659374889","IAN001","IAS001","IAF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QP/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QP/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070002-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","8"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77638IA007","7659374889","IAN001","IAS001","IAF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QP/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QP/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070002-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","9"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080004","Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080004-00","Standard Gold Off Exchange Plan","80.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$9,500","$19,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$0","$0","$200","$1,750","$0","$0","$80","10"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080004","Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080004-01","Standard Gold On Exchange Plan","80.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$9,500","$19,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$0","$0","$200","$1,750","$0","$0","$80","11"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2","77638IA008","7659374889","IAN001","IAS001","IAF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QG/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QG/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080003-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","12"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010005","Avera $2,000 / 20% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12080/Avera-2000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010005-01","Standard Silver On Exchange Plan",,"0.70502108335495","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","4","74980","IA","Individual","No","46-0451539","74980IA0020007","Avera MyPlan $5,000 / 30% Coinsurance","74980IA002",,"IAN001","IAS001","IAF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$145.86","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12143/Avera-MyPlan-5000-30-Coinsurance-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","3","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0150002","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77638IA015","7659374889","IAN001","IAS001","IAF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/EH9/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/EH9/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0150002-01","Standard Silver On Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$20","$900","$800","$0","$80","5"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","4","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160003","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77638IA016","7659374889","IAN001","IAS001","IAF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/25Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/25Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,350","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","4","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0160003","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77638IA016","7659374889","IAN001","IAS001","IAF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/25Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/25Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0160003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,350","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","Yes","93-0245545","60597ID0200001","Kids Dental Choice 20/40/50/50","60597ID020",,"IDN005","IDS004",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class I, Class II, and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Child-Only",,,,"$30.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0200001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180001","SmartAlliance Value Bronze 3000","60597ID018",,"IDN004","IDS001","IDF012","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967503&libID=4294967503","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180001-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","Yes","93-0245545","60597ID0200001","Kids Dental Choice 20/40/50/50","60597ID020",,"IDN005","IDS004",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class I, Class II, and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Child-Only",,,,"$30.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0200001-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-05","87% AV Level Silver Plan",,"0.875818610191345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,000","$0","$500","$700","$300","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-06","94% AV Level Silver Plan",,"0.930511951446533","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$300","$0","$500","$0","$300","$300","$200","$40","10"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-00","Standard Silver Off Exchange Plan",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","11"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-01","Standard Silver On Exchange Plan",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","12"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020002","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$82.39","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12134/Avera-MyPlan-150020-Coinsurance-with-Pediatric-Dental-Coverage-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020002-00","Standard Gold Off Exchange Plan",,"0.78774756193161","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010002","Avera $1,000 / 20% coinsurance","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12077/Avera-1000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010002-01","Standard Gold On Exchange Plan",,"0.788114190101624","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-03","Limited Cost Sharing Plan Variation",,"0.681809484958649","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-04","73% AV Level Silver Plan",,"0.72654926776886","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-05","87% AV Level Silver Plan",,"0.861532390117645","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020005","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$113.10","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12140/Avera-MyPlan-2500-6350-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020005-06","94% AV Level Silver Plan",,"0.938692569732666","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060001","Simplicity $500","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060001-01","Standard Platinum On Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060002","Simplicity $1,500","85930IA006",,"IAN001","IAS001","IAF004","New","HMO","Gold","No","Both","No","No",,,,"No","NO",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060002-00","Standard Gold Off Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060002","Simplicity $1,500","85930IA006",,"IAN001","IAS001","IAF004","New","HMO","Gold","No","Both","No","No",,,,"No","NO",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060002-01","Standard Gold On Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060003","Simplicity $2,000","85930IA006",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","NO",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060003-00","Standard Silver Off Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","1","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060003","Simplicity $2,000","85930IA006",,"IAN001","IAS001","IAF003","New","HMO","Silver","No","Both","No","No",,,,"No","NO",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060003-01","Standard Silver On Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","2","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060004","Simplicity $3,000","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060004-00","Standard Bronze Off Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"4"
"2014","IA","85930","SERFF","3","2013-11-27 09:24:34","2","85930","IA","SHOP (Small Group)","No","91-1842494","85930IA0060004","Simplicity $3,000","85930IA006",,"IAN001","IAS001","IAF001","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","85930IA0060004-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"5"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","1","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0010001","Guardian Pediatric Advantage","10204ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0010001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","1","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0010001","Guardian Pediatric Advantage","10204ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0010001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","1","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0020001","Guardian Pediatric Essentials","10204ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0020001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","1","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0020001","Guardian Pediatric Essentials","10204ID002",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0020001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","2","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0030001","Guardian Family Advantage Plus","10204ID003",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0030001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","2","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0030001","Guardian Family Advantage Plus","10204ID003",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0030001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","3","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0050001","Guardian Family Essentials Plus","10204ID005",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0050001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","3","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0050001","Guardian Family Essentials Plus","10204ID005",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0050001-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","4","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0040001","Guardian Family Advantage","10204ID004",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0040001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","4","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0040001","Guardian Family Advantage","10204ID004",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.76",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0040001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","10204","SERFF","3","2013-09-11 14:31:09","4","10204","ID","SHOP (Small Group)","Yes","13-5123390","10204ID0060001","Guardian Family Essentials","10204ID006",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"10204ID0060001-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-00","Standard Silver Off Exchange Plan",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-01","Standard Silver On Exchange Plan",,"0.710827827453613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-04","73% AV Level Silver Plan",,"0.730833292007446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-05","87% AV Level Silver Plan",,"0.864668190479279","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","5","74980","IA","Individual","No","46-0451539","74980IA0020009","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","74980IA002",,"IAN001","IAS001","IAF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$105.65","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12135/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020009-06","94% AV Level Silver Plan",,"0.938167095184326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","6","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010003","Avera $1,000 / 20% coinsurance, Pediatric Dental","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12149/Avera-1000-20-Coinsurance-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010003-00","Standard Gold Off Exchange Plan",,"0.788114190101624","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","6","74980","IA","Individual","No","46-0451539","74980IA0020013","Avera MyPlan $6,350","74980IA002",,"IAN001","IAS001","IAF018","New","PPO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12145/Avera-MyPlan-6350-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020013-00","Standard Catastrophic Off Exchange Plan",,,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","6","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010003","Avera $1,000 / 20% coinsurance, Pediatric Dental","74980IA001","7942203176","IAN001","IAS001","IAF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12149/Avera-1000-20-Coinsurance-Pediatric-Dental-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010003-01","Standard Gold On Exchange Plan",,"0.788114190101624","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","6","74980","IA","Individual","No","46-0451539","74980IA0020013","Avera MyPlan $6,350","74980IA002",,"IAN001","IAS001","IAF018","New","PPO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12145/Avera-MyPlan-6350-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0020013-01","Standard Catastrophic On Exchange Plan",,,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IA","74980","SERFF","6","2013-11-27 09:24:34","7","74980","IA","SHOP (Small Group)","No","46-0451539","74980IA0010006","Avera $2,000 / $6,000 Out-of-Pocket","74980IA001","7942203176","IAN001","IAS001","IAF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12152/Avera-2000-6000-Out-of-Pocket-IA.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","74980IA0010006-00","Standard Silver Off Exchange Plan",,"0.696188032627106","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","1","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0080002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77638IA008","7659374889","IAN001","IAS001","IAF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6PK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6PK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0080002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","17"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","2","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0150001","Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2","77638IA015","7659374889","IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/DK3/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/DK3/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0150001-00","Standard Gold Off Exchange Plan","78.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$10","$400","$200","$900","$700","$0","$80","4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","2","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0150001","Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2","77638IA015","7659374889","IAN001","IAS001","IAF002","New","HMO","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/DK3/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/DK3/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0150001-01","Standard Gold On Exchange Plan","78.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$10","$400","$200","$900","$700","$0","$80","5"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","2","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77638IA007","7659374889","IAN001","IAS001","IAF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6YT/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6YT/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070001-00","Standard Gold Off Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","6"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","2","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77638IA007","7659374889","IAN001","IAS001","IAF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6YT/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6YT/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070001-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","7"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","3","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0150002","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77638IA015","7659374889","IAN001","IAS001","IAF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/EH9/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/EH9/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0150002-00","Standard Silver Off Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$20","$900","$800","$0","$80","4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","5","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070003","Pathfinder POS 30/60 2400 4800 30% 5500/11/000 Rx5","77638IA007","7659374889","IAN001","IAS001","IAF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6ZC/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6ZC/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070003-00","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","4"
"2014","IA","77638","SERFF","5","2013-11-27 09:24:34","5","77638","IA","SHOP (Small Group)","No","37-1354502","77638IA0070003","Pathfinder POS 30/60 2400 4800 30% 5500/11/000 Rx5","77638IA007","7659374889","IAN001","IAS001","IAF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6ZC/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6ZC/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77638IA0070003-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030001","SelectHealth Signature $250","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030001-00","Standard Gold Off Exchange Plan",,"0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170001","SmartAlliance Balance Bronze 6350","60597ID017",,"IDN004","IDS001","IDF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170001","SmartAlliance Balance Bronze 6350","60597ID017",,"IDN004","IDS001","IDF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170001-03","Limited Cost Sharing Plan Variation",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-06","94% AV Level Silver Plan",,"0.937483370304108","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$500","$1,000","$1,000","$2,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%","$500","$1,000","20%","$12,000","$24,000","Not Applicable","Not Applicable","$300","$0","$500","$0","$300","$300","$200","$40","10"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","11","60597","ID","Individual","No","93-0245545","60597ID0150001","SmartAlliance Catastrophic","60597ID015",,"IDN004","IDS001","IDF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967622&libID=4294967622","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","www.pacificsource.com","60597ID0150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,300","$0","$0","$40","4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010002","SelectHealth Preference Gold 250 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030005","SelectHealth Signature $500 w/office ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030005-01","Standard Gold On Exchange Plan",,"0.804797053337097","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$750","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-06","94% AV Level Silver Plan","94.70%","0.946996092796326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","5%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010011","SelectHealth Preference Bronze 5350 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF011","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010011-00","Standard Bronze Off Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180004","BrightIdea Value Bronze 3000","60597ID018",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967523&libID=4294967523","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180004-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$400","11"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160002","SmartAlliance Value Bronze 3000","60597ID016",,"IDN004","IDS001","IDF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967623&libID=4294967623","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160002-03","Limited Cost Sharing Plan Variation","60.63%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010001","SelectHealth Preference Gold 250","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010001-03","Limited Cost Sharing Plan Variation","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010003","SelectHealth Preference Gold 500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010003-00","Standard Gold Off Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010004","SelectHealth Preference Gold 500 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010004-01","Standard Gold On Exchange Plan","79.10%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010004","SelectHealth Preference Gold 500 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010011","SelectHealth Preference Bronze 5350 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF011","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010011","SelectHealth Preference Bronze 5350 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF011","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010011-03","Limited Cost Sharing Plan Variation","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010018","SelectHealth HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010018-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010018-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010018","SelectHealth HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010018-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010018-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-05","87% AV Level Silver Plan","87.00%","0.870065748691559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","15%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030012","SelectHealth Signature $2,000 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF008","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030012-00","Standard Gold Off Exchange Plan",,"0.791272640228271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-06","94% AV Level Silver Plan","94.68%","0.93706750869751","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","5%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010013","SelectHealth Preference Platinum No Deductible Copay Plan","26002ID001",,"IDN001","IDS002","IDF010","New","POS","Platinum","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010013-00","Standard Platinum Off Exchange Plan","88.60%","0.88554710149765","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","3","59765","ID","Individual","No","87-0388069","59765ID0030001","BridgeSpan Exchange Bronze HSA","59765ID003",,"IDN001","IDS001","IDF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0030001-03","Limited Cost Sharing Plan Variation",,"0.589279532432556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$680","$150","$5,000","$0","$70","$80","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","Yes","93-0245545","60597ID0210001","Dental Choice 0/20/50/50 50/750","60597ID021",,"IDN006","IDS004",,"New","Indemnity","High",,"On the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Adult and Child-Only",,,,"$41.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0210001-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","1","59765","ID","Individual","No","87-0388069","59765ID0040001","BridgeSpan Exchange Catastrophic","59765ID004",,"IDN001","IDS001","IDF004","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0040001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","Not Applicable","Not Applicable","Not Applicable","$6,250","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0010001","BridgeSpan Exchange Gold","59765ID001",,"IDN001","IDS001","IDF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0010001-01","Standard Gold On Exchange Plan",,"0.784256756305695","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$5,000","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","4"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0010001","BridgeSpan Exchange Gold","59765ID001",,"IDN001","IDS001","IDF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","5"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0010001","BridgeSpan Exchange Gold","59765ID001",,"IDN001","IDS001","IDF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0010001-03","Limited Cost Sharing Plan Variation",,"0.784256756305695","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$5,000","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160006","BrightIdea Value Bronze 3000","60597ID016",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967611&libID=4294967611","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160006-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","24"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160006","BrightIdea Value Bronze 3000","60597ID016",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967611&libID=4294967611","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160006-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","25"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030012","SelectHealth Signature $2,000 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF008","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030012-01","Standard Gold On Exchange Plan",,"0.791272640228271","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010011","SelectHealth Preference Bronze 5350 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF011","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010011-01","Standard Bronze On Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-03","Limited Cost Sharing Plan Variation",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-04","73% AV Level Silver Plan",,"0.734175145626068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","25%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010019","SelectHealth Millennial 6350 (Catastrophic Plan)","26002ID001",,"IDN001","IDS002","IDF002","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010019","SelectHealth Millennial 6350 (Catastrophic Plan)","26002ID001",,"IDN001","IDS002","IDF002","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-03","Limited Cost Sharing Plan Variation","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,300","$200","$1,800","$100","$0","$80","7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-04","73% AV Level Silver Plan","73.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$11,000","$22,000","$15,850","$31,700","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,300","$200","$1,800","$100","$0","$80","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","4","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190011","SmartHealth Balance Bronze 3500","60597ID019",,"IDN001","IDS003","IDF015","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967486&libID=4294967486","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190011-01","Standard Bronze On Exchange Plan",,"0.61369776725769","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","4","60597","ID","Individual","No","93-0245545","60597ID0170012","SmartHealth Balance Gold 500","60597ID017",,"IDN001","IDS003","IDF027","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967628&libID=4294967628","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$0","$0","$0","$500","$0","$0","$40","34"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","4","60597","ID","Individual","No","93-0245545","60597ID0170012","SmartHealth Balance Gold 500","60597ID017",,"IDN001","IDS003","IDF027","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967628&libID=4294967628","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170012-03","Limited Cost Sharing Plan Variation",,"0.782082498073578","Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$0","$500","$1,600","$200","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170001","SmartAlliance Balance Bronze 6350","60597ID017",,"IDN004","IDS001","IDF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170001-00","Standard Bronze Off Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170001","SmartAlliance Balance Bronze 6350","60597ID017",,"IDN004","IDS001","IDF002","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170001-01","Standard Bronze On Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010001","SelectHealth Preference Gold 250","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010001-00","Standard Gold Off Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010001","SelectHealth Preference Gold 250","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010001-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030004","SelectHealth Signature $500","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030004-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030004-00","Standard Gold Off Exchange Plan",,"0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$750","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030004","SelectHealth Signature $500","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030004-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030004-01","Standard Gold On Exchange Plan",,"0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$750","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030007","SelectHealth Signature $1,000 (50% coinsurance)","26002ID003",,"IDN001","IDS001","IDF006","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030007-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030007-00","Standard Silver Off Exchange Plan",,"0.716733574867249","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030007","SelectHealth Signature $1,000 (50% coinsurance)","26002ID003",,"IDN001","IDS001","IDF006","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030007-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030007-01","Standard Silver On Exchange Plan",,"0.716733574867249","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010003","SelectHealth Preference Gold 500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010003-01","Standard Gold On Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030008","SelectHealth Signature $1,000 (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030008-00","Standard Gold Off Exchange Plan",,"0.806053280830383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010003","SelectHealth Preference Gold 500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030008","SelectHealth Signature $1,000 (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030008-01","Standard Gold On Exchange Plan",,"0.806053280830383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010003","SelectHealth Preference Gold 500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010003-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010003-03","Limited Cost Sharing Plan Variation","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030011","SelectHealth Signature $2,000","26002ID003",,"IDN001","IDS001","IDF005","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030011-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030011-00","Standard Silver Off Exchange Plan",,"0.695517957210541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030011","SelectHealth Signature $2,000","26002ID003",,"IDN001","IDS001","IDF005","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030011-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030011-01","Standard Silver On Exchange Plan",,"0.695517957210541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-04","73% AV Level Silver Plan","73.92%","0.73642361164093","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","15%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010005","SelectHealth Preference Silver 1000","26002ID001",,"IDN001","IDS002","IDF006","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","5%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010006","SelectHealth Preference Gold 1000","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010006-00","Standard Gold Off Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010006","SelectHealth Preference Gold 1000","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010006-01","Standard Gold On Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010006","SelectHealth Preference Gold 1000","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010006","SelectHealth Preference Gold 1000","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010006-03","Limited Cost Sharing Plan Variation","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-00","Standard Silver Off Exchange Plan","68.90%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-01","Standard Silver On Exchange Plan","68.90%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-03","Limited Cost Sharing Plan Variation","68.90%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-04","73% AV Level Silver Plan","73.92%","0.723208487033844","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","15%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010008","SelectHealth Preference Silver 2500","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010008-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010008-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","5%",,,,"$500","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010010","SelectHealth Preference Bronze 5000","26002ID001",,"IDN001","IDS002","IDF008","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010010","SelectHealth Preference Bronze 5000","26002ID001",,"IDN001","IDS002","IDF008","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","1","26002","ID","Individual","No","87-0409820","26002ID0010010","SelectHealth Preference Bronze 5000","26002ID001",,"IDN001","IDS002","IDF008","New","POS","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010002","SelectHealth Preference Gold 250 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010002-00","Standard Gold Off Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030002","SelectHealth Signature $250 w/office ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030002-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030002-01","Standard Gold On Exchange Plan",,"0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010002","SelectHealth Preference Gold 250 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010002-01","Standard Gold On Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030005","SelectHealth Signature $500 w/office ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030005-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030005-00","Standard Gold Off Exchange Plan",,"0.804797053337097","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$750","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010002","SelectHealth Preference Gold 250 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010002-03","Limited Cost Sharing Plan Variation","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030009","SelectHealth Signature $1,000 w/office ded waiver (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030009-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030009-00","Standard Gold Off Exchange Plan",,"0.785312294960022","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010004","SelectHealth Preference Gold 500 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010004-00","Standard Gold Off Exchange Plan","79.10%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030009","SelectHealth Signature $1,000 w/office ded waiver (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030009-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030009-01","Standard Gold On Exchange Plan",,"0.785312294960022","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$600","$1,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010004","SelectHealth Preference Gold 500 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010004-03","Limited Cost Sharing Plan Variation","79.10%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010007","SelectHealth Preference Gold 1000 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010007-00","Standard Gold Off Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010007","SelectHealth Preference Gold 1000 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010007-01","Standard Gold On Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010007","SelectHealth Preference Gold 1000 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","2","26002","ID","Individual","No","87-0409820","26002ID0010007","SelectHealth Preference Gold 1000 w/no deductible for office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010007-03","Limited Cost Sharing Plan Variation","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160001","SmartAlliance Value Bronze 6250","60597ID016",,"IDN004","IDS001","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967624&libID=4294967624","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160001","SmartAlliance Value Bronze 6250","60597ID016",,"IDN004","IDS001","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967624&libID=4294967624","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160001-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160002","SmartAlliance Value Bronze 3000","60597ID016",,"IDN004","IDS001","IDF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967623&libID=4294967623","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160002-00","Standard Bronze Off Exchange Plan","60.63%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180003","SmartAlliance Value Silver 2000","60597ID018",,"IDN004","IDS001","IDF010","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967504&libID=4294967504","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180003-00","Standard Silver Off Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$50","$800","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160005","BrightIdea Value Bronze 6250","60597ID016",,"IDN002","IDS002","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967612&libID=4294967612","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160005-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","21"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160005","BrightIdea Value Bronze 6250","60597ID016",,"IDN002","IDS002","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967612&libID=4294967612","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","22"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","4","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190011","SmartHealth Balance Bronze 3500","60597ID019",,"IDN001","IDS003","IDF015","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967486&libID=4294967486","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190011-00","Standard Bronze Off Exchange Plan",,"0.61369776725769","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","4","60597","ID","Individual","No","93-0245545","60597ID0170012","SmartHealth Balance Gold 500","60597ID017",,"IDN001","IDS003","IDF027","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967628&libID=4294967628","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170012-01","Standard Gold On Exchange Plan",,"0.782082498073578","Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$0","$500","$1,600","$200","$40","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","Yes","82-0344294","61589ID1720001","Dental Choice","61589ID172",,"IDN004","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Dental-Products.pdf",,"61589ID1720001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-03","Limited Cost Sharing Plan Variation","69.34%","0.693393111228943","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,633","$480","$0","$0","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190004","SmartAlliance Balance Gold 1000","60597ID019",,"IDN004","IDS001","IDF026","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967496&libID=4294967496","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190004-01","Standard Gold On Exchange Plan",,"0.783046066761017","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190007","BrightIdea Balance Silver 2000","60597ID019",,"IDN002","IDS002","IDF020","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967522&libID=4294967522","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190007-00","Standard Silver Off Exchange Plan",,"0.704089999198914","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1980001","Bronze Choice 3000","61589ID198",,"IDN001","IDS001","IDF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1980001-00","Standard Bronze Off Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","Individual","No","82-0344294","61589ID1680001","Platinum Connect Southwest","61589ID168",,"IDN002","IDS002","IDF002","New","POS","Platinum","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1680001-00","Standard Platinum Off Exchange Plan","88.20%","0.832297086715698","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$550","$1,100","0%",,,,"$550","$1,100","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$550","$270","$0","$0","$550","$490","$0","$0","4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-00","Standard Silver Off Exchange Plan","68.30%","0.694510102272034","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-01","Standard Silver On Exchange Plan","68.30%","0.694510102272034","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030006","SelectHealth Signature $500 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030006-00","Standard Gold Off Exchange Plan",,"0.805452823638916","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-03","Limited Cost Sharing Plan Variation","68.30%","0.694510102272034","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030006","SelectHealth Signature $500 w/office and Rx ded waiver","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030006-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030006-01","Standard Gold On Exchange Plan",,"0.805452823638916","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","Individual","No","87-0409820","26002ID0010009","SelectHealth Preference Silver 2500 w/4 deductible-free office visits","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx",,"http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010009-04","73% AV Level Silver Plan","72.51%","0.725060164928436","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030010","SelectHealth Signature $1,000 w/office and Rx ded waiver (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030010-00","Standard Gold Off Exchange Plan",,"0.798918724060059","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","3","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030010","SelectHealth Signature $1,000 w/office and Rx ded waiver (20% coinsurance)","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Gold","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030010-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030010-01","Standard Gold On Exchange Plan",,"0.798918724060059","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-00","Standard Silver Off Exchange Plan","70.30%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000","$16,000","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"$3,800","$7,600","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030013","SelectHealth HealthSave $1,500","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030013-00","Standard Silver Off Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030013","SelectHealth HealthSave $1,500","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030013-01","Standard Silver On Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-01","Standard Silver On Exchange Plan","70.30%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000","$16,000","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"$3,800","$7,600","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030014","SelectHealth HealthSave $2,000","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030014-00","Standard Silver Off Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-03","Limited Cost Sharing Plan Variation","70.30%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,000","$16,000","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"$3,800","$7,600","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030014","SelectHealth HealthSave $2,000","26002ID003",,"IDN001","IDS001","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030014-01","Standard Silver On Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-04","73% AV Level Silver Plan","73.84%","0.738483309745789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,300","$6,600","20%",,,,"$3,800","$7,600","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030015","SelectHealth HealthSave $3,500 (30% coinsurance)","26002ID003",,"IDN001","IDS001","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030015-00","Standard Bronze Off Exchange Plan",,"0.616917252540588","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","SHOP (Small Group)","No","87-0409820","26002ID0030015","SelectHealth HealthSave $3,500 (30% coinsurance)","26002ID003",,"IDN001","IDS001","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc",,"http://reform.selecthealth.org/product-detail/?id=26002ID0030015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0030015-01","Standard Bronze On Exchange Plan",,"0.616917252540588","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010012","SelectHealth Preference Silver 3800 Copay Plan","26002ID001",,"IDN001","IDS002","IDF009","New","POS","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010012-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010012-05","87% AV Level Silver Plan","87.27%","0.868025183677673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable","$250","$750","15%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010013","SelectHealth Preference Platinum No Deductible Copay Plan","26002ID001",,"IDN001","IDS002","IDF010","New","POS","Platinum","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010013-01","Standard Platinum On Exchange Plan","88.60%","0.887951850891113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010013","SelectHealth Preference Platinum No Deductible Copay Plan","26002ID001",,"IDN001","IDS002","IDF010","New","POS","Platinum","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","Not Applicable","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","4","26002","ID","Individual","No","87-0409820","26002ID0010013","SelectHealth Preference Platinum No Deductible Copay Plan","26002ID001",,"IDN001","IDS002","IDF010","New","POS","Platinum","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"5","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010013-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010013-03","Limited Cost Sharing Plan Variation","88.60%","0.887951850891113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$500","$1,500","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-00","Standard Silver Off Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-01","Standard Silver On Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"$500","$1,500","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010014","SelectHealth HealthSave Silver 1500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010014-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010014-06","94% AV Level Silver Plan",,"0.932928681373596","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"$500","$1,500","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-00","Standard Silver Off Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-01","Standard Silver On Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-04","73% AV Level Silver Plan",,"0.73095965385437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-05","87% AV Level Silver Plan",,"0.861791729927063","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","25%",,,,"$500","$1,500","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010015","SelectHealth HealthSave Silver 2000 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF001","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010015-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010015-06","94% AV Level Silver Plan",,"0.940203607082367","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","15%",,,,"$500","$1,500","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010016","SelectHealth HealthSave Bronze 3500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010016-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010016-00","Standard Bronze Off Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010016","SelectHealth HealthSave Bronze 3500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010016-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010016-01","Standard Bronze On Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010016","SelectHealth HealthSave Bronze 3500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010016-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010016","SelectHealth HealthSave Bronze 3500 (HSA Qualified)","26002ID001",,"IDN001","IDS002","IDF005","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010016-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010016-03","Limited Cost Sharing Plan Variation",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010017","SelectHealth HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010017-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010017-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010018","SelectHealth HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010018-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"31"
"2014","ID","26002","SERFF","6","2014-01-22 11:51:12","5","26002","ID","Individual","No","87-0409820","26002ID0010018","SelectHealth HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","26002ID001",,"IDN001","IDS002","IDF002","New","POS","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother); Acupuncture/Acupressure; Cognitive/Behavioral treatment for Attention-Deficit/Hyperactivity Disorder; Bariatric Surgery; Birthing Centers/Home Childbirth; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Adult Preventive Eye Exams; Refractive Eye Surgery; Food Supplements; Services for Gender Identity Disorder; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Mental Health Services and Diagnoses; Pervasive Developmental Disorder; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Certain Rehabilitation Therapy Services; Respite Care; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Services for Temporomandibular Joint (TMJ) and Orthognathic Conditions; and Travel-Related Expenses","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","All covered services obtained outside of the service area, except urgent, or emergency conditions, apply to nonparticipating benefits","Yes","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=26002ID0010018-00","http://selecthealth.org/i/Pages/Prescription-Drug-Lists.aspx","26002ID0010018-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170004","SmartAlliance Balance Gold 1000","60597ID017",,"IDN004","IDS001","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967619&libID=4294967619","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","Yes","93-0245545","60597ID0250002","Kids Dental Choice 0/20/50/50","60597ID025",,"IDN006","IDS004",,"New","Indemnity","High",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class I, Class II, and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Child-Only",,,,"$36.53",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0250002-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","Individual","No","93-0245545","60597ID0170009","SmartHealth Balance Bronze 6350","60597ID017",,"IDN001","IDS003","IDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170009-01","Standard Bronze On Exchange Plan",,"0.614417970180511","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","Individual","No","93-0245545","60597ID0170009","SmartHealth Balance Bronze 6350","60597ID017",,"IDN001","IDS003","IDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","1","46641","ID","Individual","Yes","82-0299431","46641ID0010001","Preferred Pediatric Plan","46641ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Child-Only",,,,"$54.54",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010001&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0010001","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010001&doc=contract",,"46641ID0010001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","1","46641","ID","Individual","Yes","82-0299431","46641ID0010001","Preferred Pediatric Plan","46641ID001",,"IDN001","IDS001",,"New","PPO","High",,"Both",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Child-Only",,,,"$54.54",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010001&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0010001","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010001&doc=contract",,"46641ID0010001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","2","46641","ID","Individual","Yes","82-0299431","46641ID0010002","Basic Pediatric Plan","46641ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Child-Only",,,,"$44.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010002&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0010002","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010002&doc=contract",,"46641ID0010002-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","2","46641","ID","Individual","Yes","82-0299431","46641ID0010002","Basic Pediatric Plan","46641ID001",,"IDN001","IDS001",,"New","PPO","Low",,"Both",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Child-Only",,,,"$44.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010002&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0010002","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0010002&doc=contract",,"46641ID0010002-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","3","46641","ID","Individual","Yes","82-0299431","46641ID0020001","Preferred Pediatric Plan Plus Adult","46641ID002",,"IDN001","IDS001",,"New","PPO","High",,"On the Exchange",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Adult and Child-Only",,,,"$54.54",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0020001&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0020001","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0020001&doc=contract",,"46641ID0020001-01","Standard High On Exchange Plan","84.30%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","46641","SERFF","4","2013-09-16 08:58:26","4","46641","ID","Individual","Yes","82-0299431","46641ID0020002","Basic Pediatric Plan Plus Adult","46641ID002",,"IDN001","IDS001",,"New","PPO","Low",,"On the Exchange",,,,"Exclusions are listed in the contract, which is included in the supporting documentation.",,,,,"Allows Adult and Child-Only",,,,"$44.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Same benefit level as in country","Yes","Same benefit level as in area","Yes","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0020002&doc=summary","go.deltadentalid.com/healthexchange/payment.aspx?plan=46641ID0020002","go.deltadentalid.com/healthexchange/default.aspx?plan=46641ID0020002&doc=contract",,"46641ID0020002-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-01","Standard Silver On Exchange Plan",,"0.692280411720276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$3,000","$20","$850","$150","$3,000","$200","$190","$80","7"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","8"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-03","Limited Cost Sharing Plan Variation",,"0.692280411720276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$3,000","$20","$850","$150","$3,000","$200","$190","$80","9"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-04","73% AV Level Silver Plan",,"0.738602876663208","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$2,500","$20","$950","$150","$2,500","$240","$220","$80","10"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-05","87% AV Level Silver Plan",,"0.865136981010437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$500","$0","$1,000","$150","$500","$380","$440","$80","11"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","2","59765","ID","Individual","No","87-0388069","59765ID0020001","BridgeSpan Exchange Silver","59765ID002",,"IDN001","IDS001","IDF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0020001-06","94% AV Level Silver Plan",,"0.936659097671509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$200","$0","$300","$150","$200","$180","$120","$80","12"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","3","59765","ID","Individual","No","87-0388069","59765ID0030001","BridgeSpan Exchange Bronze HSA","59765ID003",,"IDN001","IDS001","IDF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0030001-01","Standard Bronze On Exchange Plan",,"0.589279532432556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$680","$150","$5,000","$0","$70","$80","4"
"2014","ID","59765","SERFF","2","2013-09-19 10:34:04","3","59765","ID","Individual","No","87-0388069","59765ID0030001","BridgeSpan Exchange Bronze HSA","59765ID003",,"IDN001","IDS001","IDF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9986",,,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","59765ID0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160001","SmartAlliance Value Bronze 6250","60597ID016",,"IDN004","IDS001","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967624&libID=4294967624","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160001-00","Standard Bronze Off Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160001","SmartAlliance Value Bronze 6250","60597ID016",,"IDN004","IDS001","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967624&libID=4294967624","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160001-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180001","SmartAlliance Value Bronze 3000","60597ID018",,"IDN004","IDS001","IDF012","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967503&libID=4294967503","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180001-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160002","SmartAlliance Value Bronze 3000","60597ID016",,"IDN004","IDS001","IDF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967623&libID=4294967623","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160002-01","Standard Bronze On Exchange Plan","60.63%","0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180003","SmartAlliance Value Silver 2000","60597ID018",,"IDN004","IDS001","IDF010","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967504&libID=4294967504","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180003-01","Standard Silver On Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$50","$800","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180004","BrightIdea Value Bronze 3000","60597ID018",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967523&libID=4294967523","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180004-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$400","10"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160002","SmartAlliance Value Bronze 3000","60597ID016",,"IDN004","IDS001","IDF012","New","HMO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967623&libID=4294967623","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","10"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-00","Standard Silver Off Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","12"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-01","Standard Silver On Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","13"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180007","SmartHealth Value Bronze 3000","60597ID018",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967493&libID=4294967493","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180007-01","Standard Bronze On Exchange Plan",,"0.60104763507843","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160009","SmartHealth Value Bronze 6250","60597ID016",,"IDN001","IDS003","IDF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967633&libID=4294967633","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160009-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$0","$5,300","$0","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160009","SmartHealth Value Bronze 6250","60597ID016",,"IDN001","IDS003","IDF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967633&libID=4294967633","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160009","SmartHealth Value Bronze 6250","60597ID016",,"IDN001","IDS003","IDF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967633&libID=4294967633","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160009-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$0","$5,300","$0","$0","$40","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","Yes","82-0344294","61589ID1920001","Group Dental Choice Plus","61589ID192",,"IDN004","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf",,"61589ID1920001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1960001","Gold Choice 2000","61589ID196",,"IDN001","IDS001","IDF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1960001-01","Standard Gold On Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1950001","Gold Choice 1000","61589ID195",,"IDN001","IDS001","IDF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1950001-00","Standard Gold Off Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","Yes","82-0344294","61589ID1930001","Group Dental Choice","61589ID193",,"IDN004","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf",,"61589ID1930001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","Individual","No","82-0344294","61589ID1680001","Platinum Connect Southwest","61589ID168",,"IDN002","IDS002","IDF002","New","POS","Platinum","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1680001-03","Limited Cost Sharing Plan Variation","88.20%","0.832297086715698","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$550","$1,100","0%",,,,"$550","$1,100","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$550","$270","$0","$0","$550","$490","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2150001","Bronze Point 3000","61589ID215",,"IDN005","IDS001","IDF004","New","POS","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2150001-01","Standard Bronze On Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2060001","Gold Connect East 2000","61589ID206",,"IDN003","IDS003","IDF005","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2060001-01","Standard Gold On Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","21"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1630001","Gold Choice","61589ID163",,"IDN001","IDS001","IDF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1630001-03","Limited Cost Sharing Plan Variation","78.67%","0.786702811717987","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$480","$95","$0","21"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2120001","Gold Point 1000","61589ID212",,"IDN005","IDS001","IDF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2120001-00","Standard Gold Off Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","22"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1670001","Gold Connect Southwest","61589ID167",,"IDN002","IDS002","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1670001-00","Standard Gold Off Exchange Plan","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","22"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-04","73% AV Level Silver Plan",,"0.728329539299011","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$2,700","$5,400","$4,000","$8,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%","$4,000","$8,000","0%","$12,000","$24,000","Not Applicable","Not Applicable","$2,700","$0","$0","$0","$2,700","$0","$0","$40","16"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-05","87% AV Level Silver Plan",,"0.867675185203552","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%","$2,000","$4,000","0%","$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$0","$0","$0","$1,000","$0","$0","$40","17"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-06","94% AV Level Silver Plan",,"0.940314114093781","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$400","$800","$800","$1,600","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%","$800","$1,600","0%","$12,000","$24,000","Not Applicable","Not Applicable","$400","$0","$0","$0","$400","$0","$0","$40","18"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170004","SmartAlliance Balance Gold 1000","60597ID017",,"IDN004","IDS001","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967619&libID=4294967619","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170004-01","Standard Gold On Exchange Plan",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1950001","Gold Choice 1000","61589ID195",,"IDN001","IDS001","IDF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1950001-01","Standard Gold On Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","Yes","82-0344294","61589ID1930001","Group Dental Choice","61589ID193",,"IDN004","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf",,"61589ID1930001-01","Standard Low On Exchange Plan","69.80%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-04","73% AV Level Silver Plan","72.82%","0.728232026100159","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$8,350","$16,700","Not Applicable","Not Applicable","$2,900","$5,800","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,300","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$1,633","$480","$0","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1940001","Gold Choice 500","61589ID194",,"IDN001","IDS001","IDF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1940001-00","Standard Gold Off Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1670001","Gold Connect Southwest","61589ID167",,"IDN002","IDS002","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1670001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","24"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2110001","Gold Point 500","61589ID211",,"IDN005","IDS001","IDF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2110001-00","Standard Gold Off Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","24"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-01","Standard Silver On Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","52"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","53"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180006","BrightIdea Value Silver 2000","60597ID018",,"IDN002","IDS002","IDF010","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967524&libID=4294967524","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180006-00","Standard Silver Off Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$0","$800","$40","14"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","14"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180006","BrightIdea Value Silver 2000","60597ID018",,"IDN002","IDS002","IDF010","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967524&libID=4294967524","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180006-01","Standard Silver On Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$0","$800","$40","15"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-03","Limited Cost Sharing Plan Variation",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","15"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-04","73% AV Level Silver Plan",,"0.735637664794922","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,700","$0","$0","$0","$2,700","$0","$0","$40","16"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$0","$0","$0","$1,000","$0","$0","$40","17"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160003","SmartAlliance Value Silver 3600","60597ID016",,"IDN004","IDS001","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160003-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$0","$0","$0","$500","$0","$0","$40","18"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160005","BrightIdea Value Bronze 6250","60597ID016",,"IDN002","IDS002","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967612&libID=4294967612","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160005-00","Standard Bronze Off Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","20"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160005","BrightIdea Value Bronze 6250","60597ID016",,"IDN002","IDS002","IDF004","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967612&libID=4294967612","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160005-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,250","$0","$0","$0","$5,300","$0","$0","$40","23"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160006","BrightIdea Value Bronze 3000","60597ID016",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967611&libID=4294967611","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","26"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160006","BrightIdea Value Bronze 3000","60597ID016",,"IDN002","IDS002","IDF012","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967611&libID=4294967611","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160006-03","Limited Cost Sharing Plan Variation",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","27"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-00","Standard Silver Off Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","28"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-01","Standard Silver On Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","29"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190008","BrightIdea Balance Silver 1500","60597ID019",,"IDN002","IDS002","IDF022","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967520&libID=4294967520","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190008-01","Standard Silver On Exchange Plan",,"0.717391014099121","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","14"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190009","BrightIdea Balance Gold 1000","60597ID019",,"IDN002","IDS002","IDF026","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967518&libID=4294967518","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190009-00","Standard Gold Off Exchange Plan",,"0.783046066761017","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","15"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2050001","Gold Connect East 1000","61589ID205",,"IDN003","IDS003","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2050001-00","Standard Gold Off Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","16"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-05","87% AV Level Silver Plan","87.22%","0.872181534767151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","25%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$1,875","$0","$0","$0","$1,325","$0","16"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-05","87% AV Level Silver Plan","86.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,500","$23,000","$13,350","$26,700","$150","$300","25%",,,,"$3,500","$7,000","$3,650","$7,300","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$150","$20","$1,700","$200","$150","$700","$300","$80","24"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,500","$23,000","$26,700","$26,700","$0","$0","3%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$20","$200","$200","$0","$700","$30","$80","25"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-00","Standard Silver Off Exchange Plan","70.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","26"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-01","Standard Silver On Exchange Plan","70.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","27"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","30"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-03","Limited Cost Sharing Plan Variation",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","31"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-04","73% AV Level Silver Plan",,"0.735637664794922","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,700","$0","$0","$0","$2,700","$0","$0","$40","32"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","1","60597","ID","Individual","No","93-0245545","60597ID0160007","BrightIdea Value Silver 3600","60597ID016",,"IDN002","IDS002","IDF006","New","HMO","Silver","No","Both","No","No",,,"$35.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967626&libID=4294967626","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160007-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$0","$0","$0","$1,000","$0","$0","$40","33"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","SHOP (Small Group)","Yes","93-0245545","60597ID0210002","Dental Choice Core","60597ID021",,"IDN006","IDS004",,"New","Indemnity","High",,"On the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class II Complicated services and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Adult and Child-Only",,,,"$41.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0210002-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160009","SmartHealth Value Bronze 6250","60597ID016",,"IDN001","IDS003","IDF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967633&libID=4294967633","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160009-00","Standard Bronze Off Exchange Plan",,"0.583353817462921","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$0","$5,300","$0","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180007","SmartHealth Value Bronze 3000","60597ID018",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967493&libID=4294967493","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180007-00","Standard Bronze Off Exchange Plan",,"0.60104763507843","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$300","$800","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180009","SmartHealth Value Silver 2000","60597ID018",,"IDN001","IDS003","IDF011","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967494&libID=4294967494","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180009-00","Standard Silver Off Exchange Plan",,"0.687976181507111","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$0","$800","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160010","SmartHealth Value Bronze 3000","60597ID016",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967632&libID=4294967632","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160010-00","Standard Bronze Off Exchange Plan",,"0.599680423736572","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0180009","SmartHealth Value Silver 2000","60597ID018",,"IDN001","IDS003","IDF011","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967494&libID=4294967494","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0180009-01","Standard Silver On Exchange Plan",,"0.687976181507111","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$0","$800","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160010","SmartHealth Value Bronze 3000","60597ID016",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967632&libID=4294967632","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160010-01","Standard Bronze On Exchange Plan",,"0.599680423736572","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160010","SmartHealth Value Bronze 3000","60597ID016",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967632&libID=4294967632","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","10"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160010","SmartHealth Value Bronze 3000","60597ID016",,"IDN001","IDS003","IDF013","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967632&libID=4294967632","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160010-03","Limited Cost Sharing Plan Variation",,"0.599680423736572","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$0","$3,000","$0","$1,100","$40","11"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-00","Standard Silver Off Exchange Plan",,"0.680988490581512","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%","$4,000","$8,000","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","12"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-01","Standard Silver On Exchange Plan",,"0.680988490581512","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%","$4,000","$8,000","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","13"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","14"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","2","60597","ID","Individual","No","93-0245545","60597ID0160011","SmartHealth Value Silver 3600","60597ID016",,"IDN001","IDS003","IDF007","New","HMO","Silver","No","Both","No","No",,,"$30.00","Yes",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967635&libID=4294967635","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0160011-03","Limited Cost Sharing Plan Variation",,"0.680988490581512","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$3,600","$7,200","$4,000","$8,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%","$4,000","$8,000","0%","$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","15"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","Yes","93-0245545","60597ID0250001","Kids Dental Choice 20/40/50/50","60597ID025",,"IDN006","IDS004",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class I, Class II, and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Child-Only",,,,"$29.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0250001-00","Standard Low Off Exchange Plan","68.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190001","SmartAlliance Balance Bronze 3500","60597ID019",,"IDN004","IDS001","IDF014","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967498&libID=4294967498","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190001-00","Standard Bronze Off Exchange Plan",,"0.614953696727753","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190001","SmartAlliance Balance Bronze 3500","60597ID019",,"IDN004","IDS001","IDF014","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967498&libID=4294967498","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190001-01","Standard Bronze On Exchange Plan",,"0.614953696727753","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","Yes","93-0245545","60597ID0250001","Kids Dental Choice 20/40/50/50","60597ID025",,"IDN006","IDS004",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated other than deemed essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone replacement grafts to prepare for implants after extraction. Broken appointments. Class I, Class II, and Class III services for members age 19 and older. Collection of cultures and specimens. Connector bar or stress breaker. Core build-ups unless tooth treated endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth.  Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs and medications. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except administered with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery.. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of clinically serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy to mercury. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge made. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability.  Tooth transplantation except re-implantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War-related conditions. Work-related conditions.",,,,,"Allows Child-Only",,,,"$29.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,,,"60597ID0250001-01","Standard Low On Exchange Plan","68.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$1,000","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190006","BrightIdea Balance Bronze 3500","60597ID019",,"IDN002","IDS002","IDF014","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967516&libID=4294967516","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190006-00","Standard Bronze Off Exchange Plan",,"0.614953696727753","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170004","SmartAlliance Balance Gold 1000","60597ID017",,"IDN004","IDS001","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967619&libID=4294967619","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170004-03","Limited Cost Sharing Plan Variation",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190006","BrightIdea Balance Bronze 3500","60597ID019",,"IDN002","IDS002","IDF014","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967516&libID=4294967516","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190006-01","Standard Bronze On Exchange Plan",,"0.614953696727753","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170008","BrightIdea Balance Gold 1000","60597ID017",,"IDN002","IDS002","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967615&libID=4294967615","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170008-01","Standard Gold On Exchange Plan",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170008","BrightIdea Balance Gold 1000","60597ID017",,"IDN002","IDS002","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967615&libID=4294967615","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","3","60597","ID","Individual","No","93-0245545","60597ID0170008","BrightIdea Balance Gold 1000","60597ID017",,"IDN002","IDS002","IDF026","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967615&libID=4294967615","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170008-03","Limited Cost Sharing Plan Variation",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","46"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-03","Limited Cost Sharing Plan Variation","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","47"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2150001","Bronze Point 3000","61589ID215",,"IDN005","IDS001","IDF004","New","POS","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2150001-00","Standard Bronze Off Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","Individual","No","82-0344294","61589ID1680001","Platinum Connect Southwest","61589ID168",,"IDN002","IDS002","IDF002","New","POS","Platinum","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1680001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 RX2","20129IL031","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6LX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6LX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310001-00","Standard Gold Off Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,100","$200","$900","$600","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 RX2","20129IL031","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6LX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6LX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310001-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,100","$200","$900","$600","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,300","$200","$1,800","$100","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320001","Guide HMO 25/50 1600/3200 10% 4000/8000 RX2","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Gold","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/19V/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/19V/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0320001-00","Standard Gold Off Exchange Plan","78.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$0","$500","$200","$900","$700","$0","$80","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0320001","Guide HMO 25/50 1600/3200 10% 4000/8000 RX2","20129IL032","7740283974","ILN001","ILS001","ILF002","New","HMO","Gold","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/19V/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/19V/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0320001-01","Standard Gold On Exchange Plan","78.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,600","$0","$500","$200","$900","$700","$0","$80","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170005","BrightIdea Balance Bronze 6350","60597ID017",,"IDN002","IDS002","IDF002","New","HMO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967608&libID=4294967608","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170005-01","Standard Bronze On Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170005","BrightIdea Balance Bronze 6350","60597ID017",,"IDN002","IDS002","IDF002","New","HMO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967608&libID=4294967608","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-01","Standard Silver On Exchange Plan","69.34%","0.693393111228943","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,633","$480","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","Yes","82-0344294","61589ID1710001","Dental Choice Plus","61589ID171",,"IDN004","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Dental-Products.pdf",,"61589ID1710001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL028","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NN/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NN/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280003-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","9"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","9"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310002","Pathfinder POS 1750/3500 30% 5500/11000 RX3","20129IL031","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310002-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,750","$500","$200","$80","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","Yes","82-0344294","61589ID1720001","Dental Choice","61589ID172",,"IDN004","IDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Dental-Products.pdf",,"61589ID1720001-00","Standard Low Off Exchange Plan","69.80%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1810001","Gold Connect East","61589ID181",,"IDN003","IDS003","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1810001-00","Standard Gold Off Exchange Plan","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","26"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2130001","Gold Point 2000","61589ID213",,"IDN005","IDS001","IDF005","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2130001-00","Standard Gold Off Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","26"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1810001","Gold Connect East","61589ID181",,"IDN003","IDS003","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1810001-01","Standard Gold On Exchange Plan","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","27"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2130001","Gold Point 2000","61589ID213",,"IDN005","IDS001","IDF005","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2130001-01","Standard Gold On Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","27"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2100001","Bronze HSA Saver","61589ID210",,"IDN001","IDS001","IDF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2100001-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$5,300","$0","$0","$0","6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1600001","Bronze Choice","61589ID160",,"IDN001","IDS001","IDF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1600001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","5","60597","ID","Individual","No","93-0245545","60597ID0170005","BrightIdea Balance Bronze 6350","60597ID017",,"IDN002","IDS002","IDF002","New","HMO","Bronze","No","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967608&libID=4294967608","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170005-03","Limited Cost Sharing Plan Variation",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","11"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-00","Standard Silver Off Exchange Plan",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-01","Standard Silver On Exchange Plan",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-03","Limited Cost Sharing Plan Variation",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170002","SmartAlliance Balance Silver 2500","60597ID017",,"IDN004","IDS001","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967621&libID=4294967621","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170002-04","73% AV Level Silver Plan",,"0.729876935482025","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$2,000","$900","$50","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","13"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-03","Limited Cost Sharing Plan Variation",,"0.681437492370605","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","14"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-04","73% AV Level Silver Plan",,"0.729876935482025","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$2,000","$900","$50","$40","15"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-05","87% AV Level Silver Plan",,"0.875818610191345","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$0","$1,000","$0","$500","$700","$300","$40","16"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","6","60597","ID","Individual","No","93-0245545","60597ID0170006","BrightIdea Balance Silver 2500","60597ID017",,"IDN002","IDS002","IDF018","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967610&libID=4294967610","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170006-06","94% AV Level Silver Plan",,"0.930511951446533","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$300","$0","$500","$0","$300","$300","$200","$40","17"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190002","SmartAlliance Balance Silver 2000","60597ID019",,"IDN004","IDS001","IDF020","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967502&libID=4294967502","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190002-00","Standard Silver Off Exchange Plan",,"0.704089999198914","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","Individual","No","93-0245545","60597ID0170009","SmartHealth Balance Bronze 6350","60597ID017",,"IDN001","IDS003","IDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170009-00","Standard Bronze Off Exchange Plan",,"0.614417970180511","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190002","SmartAlliance Balance Silver 2000","60597ID019",,"IDN004","IDS001","IDF020","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967502&libID=4294967502","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190002-01","Standard Silver On Exchange Plan",,"0.704089999198914","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190003","SmartAlliance Balance Silver 1500","60597ID019",,"IDN004","IDS001","IDF022","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967500&libID=4294967500","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190003-00","Standard Silver Off Exchange Plan",,"0.717391014099121","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","Individual","No","93-0245545","60597ID0170009","SmartHealth Balance Bronze 6350","60597ID017",,"IDN001","IDS003","IDF003","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967618&libID=4294967618","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170009-03","Limited Cost Sharing Plan Variation",,"0.614417970180511","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190003","SmartAlliance Balance Silver 1500","60597ID019",,"IDN004","IDS001","IDF022","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967500&libID=4294967500","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190003-01","Standard Silver On Exchange Plan",,"0.717391014099121","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190004","SmartAlliance Balance Gold 1000","60597ID019",,"IDN004","IDS001","IDF026","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967496&libID=4294967496","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190004-00","Standard Gold Off Exchange Plan",,"0.783046066761017","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190007","BrightIdea Balance Silver 2000","60597ID019",,"IDN002","IDS002","IDF020","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967522&libID=4294967522","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190007-01","Standard Silver On Exchange Plan",,"0.704089999198914","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","12"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190008","BrightIdea Balance Silver 1500","60597ID019",,"IDN002","IDS002","IDF022","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967520&libID=4294967520","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190008-00","Standard Silver Off Exchange Plan",,"0.717391014099121","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","13"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","7","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190009","BrightIdea Balance Gold 1000","60597ID019",,"IDN002","IDS002","IDF026","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967518&libID=4294967518","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190009-01","Standard Gold On Exchange Plan",,"0.783046066761017","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","16"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190012","SmartHealth Balance Silver 2000","60597ID019",,"IDN001","IDS003","IDF021","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967492&libID=4294967492","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190012-00","Standard Silver Off Exchange Plan",,"0.691885471343994","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-00","Standard Silver Off Exchange Plan",,"0.680464684963226","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%","$3,000","$6,000","40%","$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","4"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190012","SmartHealth Balance Silver 2000","60597ID019",,"IDN001","IDS003","IDF021","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967492&libID=4294967492","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190012-01","Standard Silver On Exchange Plan",,"0.691885471343994","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,200","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-01","Standard Silver On Exchange Plan",,"0.680464684963226","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%","$3,000","$6,000","40%","$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190013","SmartHealth Balance Silver 1500","60597ID019",,"IDN001","IDS003","IDF023","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967490&libID=4294967490","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190013-00","Standard Silver Off Exchange Plan",,"0.704978227615356","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","6"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190013","SmartHealth Balance Silver 1500","60597ID019",,"IDN001","IDS003","IDF023","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967490&libID=4294967490","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190013-01","Standard Silver On Exchange Plan",,"0.704978227615356","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$2,000","$4,000","50%","$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-03","Limited Cost Sharing Plan Variation",,"0.680464684963226","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%","$3,000","$6,000","40%","$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,400","$0","$2,200","$1,900","$0","$40","7"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-04","73% AV Level Silver Plan",,"0.727829992771149","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$3,000","$6,000","40%","$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$2,000","$900","$50","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","SHOP (Small Group)","No","93-0245545","60597ID0190014","SmartHealth Balance Gold 500","60597ID019",,"IDN001","IDS003","IDF027","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967488&libID=4294967488","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/idaho-small-group-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0190014-00","Standard Gold Off Exchange Plan",,"0.78199565410614","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,000","$2,000","30%","$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$40","$500","$1,700","$200","$40","8"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","8","60597","ID","Individual","No","93-0245545","60597ID0170010","SmartHealth Balance Silver 2500","60597ID017",,"IDN001","IDS003","IDF017","New","HMO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967630&libID=4294967630","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","http://www.pacificsource.com/drug-list/","60597ID0170010-05","87% AV Level Silver Plan",,"0.870193421840668","Yes","Yes","Yes","90%","10%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$2,250","$4,500","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$1,500","$3,000","30%","$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,000","$0","$500","$700","$300","$40","9"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","11","60597","ID","Individual","No","93-0245545","60597ID0150002","BrightIdea Catastrophic","60597ID015",,"IDN002","IDS002","IDF001","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967616&libID=4294967616","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","www.pacificsource.com","60597ID0150002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,300","$0","$0","$40","5"
"2014","ID","60597","SERFF","9","2013-10-16 19:58:29","12","60597","ID","Individual","No","93-0245545","60597ID0150003","SmartHealth Catastrophic","60597ID015",,"IDN001","IDS003","IDF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes",,,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency care only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967631&libID=4294967631","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/idaho-individual-plan-details/","www.pacificsource.com","60597ID0150003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$0","$0","$40","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","Yes","82-0344294","61589ID1920001","Group Dental Choice Plus","61589ID192",,"IDN004","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf",,"61589ID1920001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-00","Standard Silver Off Exchange Plan","69.34%","0.693393111228943","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,633","$480","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","Yes","82-0344294","61589ID1710001","Dental Choice Plus","61589ID171",,"IDN004","IDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes",,"https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Dental-Products.pdf",,"61589ID1710001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$1,000","Not Applicable",,,"$10,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1960001","Gold Choice 2000","61589ID196",,"IDN001","IDS001","IDF005","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1960001-00","Standard Gold Off Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-00","Standard Silver Off Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","44"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-01","Standard Silver On Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","45"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020002",,"18715IL0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","2","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020006",,"18715IL0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","2","18715","IL","Individual","Yes","75-1233841","18715IL0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","18715IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010006",,"18715IL0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","2","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020006",,"18715IL0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","2","18715","IL","Individual","Yes","75-1233841","18715IL0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","18715IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010006",,"18715IL0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","3","18715","IL","Individual","Yes","75-1233841","18715IL0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","18715IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010004",,"18715IL0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","3","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020004",,"18715IL0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","3","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020004",,"18715IL0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","3","18715","IL","Individual","Yes","75-1233841","18715IL0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","18715IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010004",,"18715IL0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-05","87% AV Level Silver Plan","86.03%","0.860300183296204","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$8,350","$16,700","Not Applicable","Not Applicable","$150","$300","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$150","Not Applicable",,,,,,,,,,,"$150","$70","$2,100","$0","$150","$480","$445","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1940001","Gold Choice 500","61589ID194",,"IDN001","IDS001","IDF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1940001-01","Standard Gold On Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1610001","Silver Choice","61589ID161",,"IDN001","IDS001","IDF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1610001-06","94% AV Level Silver Plan","93.09%","0.930914402008057","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$0","$70","$730","$0","$0","$480","$163","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1990001","Gold Connect Southwest 500","61589ID199",,"IDN002","IDS002","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1990001-00","Standard Gold Off Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-00","Standard Silver Off Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1990001","Gold Connect Southwest 500","61589ID199",,"IDN002","IDS002","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1990001-01","Standard Gold On Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2010001","Gold Connect Southwest 2000","61589ID201",,"IDN002","IDS002","IDF005","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2010001-00","Standard Gold Off Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","12"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-01","Standard Silver On Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","12"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2010001","Gold Connect Southwest 2000","61589ID201",,"IDN002","IDS002","IDF005","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2010001-01","Standard Gold On Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","13"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2000001","Gold Connect Southwest 1000","61589ID200",,"IDN002","IDS002","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2000001-00","Standard Gold Off Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","14"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-03","Limited Cost Sharing Plan Variation","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","14"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-04","73% AV Level Silver Plan","72.94%","0.729393482208252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","15"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2000001","Gold Connect Southwest 1000","61589ID200",,"IDN002","IDS002","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2000001-01","Standard Gold On Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","15"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2050001","Gold Connect East 1000","61589ID205",,"IDN003","IDS003","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2050001-01","Standard Gold On Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","17"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1620001","Silver Choice No Deductible","61589ID162",,"IDN001","IDS001","IDF001","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1620001-06","94% AV Level Silver Plan","93.28%","0.932817757129669","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$8,350","$16,700","Not Applicable","Not Applicable","$0","$0","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","10%",,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$750","$0","$0","$0","$530","$0","17"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1630001","Gold Choice","61589ID163",,"IDN001","IDS001","IDF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1630001-00","Standard Gold Off Exchange Plan","78.67%","0.786702811717987","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$480","$95","$0","18"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2040001","Gold Connect East 500","61589ID204",,"IDN003","IDS003","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2040001-00","Standard Gold Off Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","18"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1630001","Gold Choice","61589ID163",,"IDN001","IDS001","IDF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1630001-01","Standard Gold On Exchange Plan","78.67%","0.786702811717987","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$480","$95","$0","19"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2040001","Gold Connect East 500","61589ID204",,"IDN003","IDS003","IDF004","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2040001-01","Standard Gold On Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","19"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2060001","Gold Connect East 2000","61589ID206",,"IDN003","IDS003","IDF005","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2060001-00","Standard Gold Off Exchange Plan","78.2%","0","No","No","No","100%",,"$3,500","$7,000",,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,060","$0","$1,400","$600","$0","$0","20"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1630001","Gold Choice","61589ID163",,"IDN001","IDS001","IDF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1630001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1670001","Gold Connect Southwest","61589ID167",,"IDN002","IDS002","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1670001-01","Standard Gold On Exchange Plan","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","23"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2120001","Gold Point 1000","61589ID212",,"IDN005","IDS001","IDF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2120001-01","Standard Gold On Exchange Plan","78.3%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$1,000","$2,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,000","$70","$1,260","$0","$1,000","$700","$80","$0","23"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1670001","Gold Connect Southwest","61589ID167",,"IDN002","IDS002","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1670001-03","Limited Cost Sharing Plan Variation","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","25"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2110001","Gold Point 500","61589ID211",,"IDN005","IDS001","IDF004","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2110001-01","Standard Gold On Exchange Plan","80.9%","0","No","No","No","100%",,"$4,000","$8,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"$500","$1,000","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$500","$70","$1,360","$0","$500","$700","$180","$0","25"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1810001","Gold Connect East","61589ID181",,"IDN003","IDS003","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1810001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","28"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1810001","Gold Connect East","61589ID181",,"IDN003","IDS003","IDF002","New","POS","Gold","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1810001-03","Limited Cost Sharing Plan Variation","78.61%","0.786086738109589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","15%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$70","$945","$0","$1,000","$490","$77","$0","29"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-00","Standard Silver Off Exchange Plan","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","30"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-01","Standard Silver On Exchange Plan","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","31"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","32"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-03","Limited Cost Sharing Plan Variation","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","33"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-04","73% AV Level Silver Plan","72.97%","0.729730129241943","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,900","$5,800","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,300","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$1,517","$490","$0","$0","34"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-05","87% AV Level Silver Plan","86.06%","0.860619127750397","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$150","$300","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$150","Not Applicable",,,,,,,,,,,"$150","$70","$2,100","$0","$150","$490","$410","$0","35"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1650001","Silver Connect Southwest","61589ID165",,"IDN002","IDS002","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1650001-06","94% AV Level Silver Plan","93.09%","0.930943071842194","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$0","$70","$730","$0","$0","$490","$152","$0","36"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-00","Standard Silver Off Exchange Plan","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","37"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790005","Blue Choice Bronze PPO 005","36096IL079",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790005-00","Standard Bronze Off Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids 1A","36096IL083",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0060003","Bronze $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72210","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0060003","Bronze $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72210","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060003-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0070003","Bronze $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72225","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0070003","Bronze $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72225","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0070003","Bronze $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72225","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0070003","Bronze $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72225","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Bronze Deductible Only PPO HSA Eligible Plan","35670IL006",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72227","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Bronze Deductible Only PPO HSA Eligible Plan","35670IL006",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72227","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840009","BlueCare Dental 1G","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840009-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790002","Blue Choice Gold PPO 002","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800002","Blue Choice Gold PPO 002","36096IL080",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-01","Standard Silver On Exchange Plan","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","38"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","39"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-03","Limited Cost Sharing Plan Variation","69.50%","0.694983899593353","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,350","Not Applicable",,,,,,,,,,,"$4,000","$70","$990","$0","$1,517","$490","$0","$0","40"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-04","73% AV Level Silver Plan","72.97%","0.729730129241943","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,900","$5,800","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$2,300","Not Applicable",,,,,,,,,,,"$2,900","$70","$1,320","$0","$1,517","$490","$0","$0","41"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-05","87% AV Level Silver Plan","86.06%","0.860619127750397","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$150","$300","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$150","Not Applicable",,,,,,,,,,,"$150","$70","$2,100","$0","$150","$490","$410","$0","42"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1790001","Silver Connect East","61589ID179",,"IDN003","IDS003","IDF002","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1790001-06","94% AV Level Silver Plan","93.09%","0.930943071842194","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$0","$70","$730","$0","$0","$490","$152","$0","43"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-04","73% AV Level Silver Plan","72.94%","0.729393482208252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","48"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-05","87% AV Level Silver Plan","87.22%","0.872181534767151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$1,875","$0","$0","$0","$1,325","$0","49"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1660001","Silver Connect Southwest No Deductible","61589ID166",,"IDN002","IDS002","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1660001-06","94% AV Level Silver Plan","93.28%","0.932817757129669","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$750","$0","$0","$0","$530","$0","50"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-00","Standard Silver Off Exchange Plan","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","51"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-03","Limited Cost Sharing Plan Variation","70.93%","0.709274232387543","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","54"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-04","73% AV Level Silver Plan","72.94%","0.729393482208252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$3,750","$0","$0","$0","$2,650","$0","55"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-05","87% AV Level Silver Plan","87.22%","0.872181534767151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","25%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$1,875","$0","$0","$0","$1,325","$0","56"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","1","61589","ID","Individual","No","82-0344294","61589ID1800001","Silver Connect East No Deductible","61589ID180",,"IDN003","IDS003","IDF001","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1800001-06","94% AV Level Silver Plan","93.28%","0.932817757129669","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","Not Applicable","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$750","$0","$0","$0","$530","$0","57"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1600001","Bronze Choice","61589ID160",,"IDN001","IDS001","IDF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1600001-00","Standard Bronze Off Exchange Plan","60.02%","0.600197911262512","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,533","$240","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2090001","Silver HSA Saver","61589ID209",,"IDN001","IDS001","IDF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2090001-00","Standard Silver Off Exchange Plan",,"0.698268175125122","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$120","$600","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1600001","Bronze Choice","61589ID160",,"IDN001","IDS001","IDF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1600001-01","Standard Bronze On Exchange Plan","60.02%","0.600197911262512","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,533","$240","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2090001","Silver HSA Saver","61589ID209",,"IDN001","IDS001","IDF006","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2090001-01","Standard Silver On Exchange Plan",,"0.698268175125122","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$120","$600","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1600001","Bronze Choice","61589ID160",,"IDN001","IDS001","IDF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","4","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1600001-03","Limited Cost Sharing Plan Variation","60.02%","0.600197911262512","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,533","$240","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2100001","Bronze HSA Saver","61589ID210",,"IDN001","IDS001","IDF001","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2100001-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$5,300","$0","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1640001","Bronze Connect Southwest","61589ID164",,"IDN002","IDS002","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1640001-00","Standard Bronze Off Exchange Plan","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1640001","Bronze Connect Southwest","61589ID164",,"IDN002","IDS002","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1640001-01","Standard Bronze On Exchange Plan","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1640001","Bronze Connect Southwest","61589ID164",,"IDN002","IDS002","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1640001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1640001","Bronze Connect Southwest","61589ID164",,"IDN002","IDS002","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1640001-03","Limited Cost Sharing Plan Variation","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1780001","Bronze Connect East","61589ID178",,"IDN003","IDS003","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1780001-00","Standard Bronze Off Exchange Plan","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","12"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1780001","Bronze Connect East","61589ID178",,"IDN003","IDS003","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1780001-01","Standard Bronze On Exchange Plan","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","13"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1780001","Bronze Connect East","61589ID178",,"IDN003","IDS003","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1780001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","2","61589","ID","Individual","No","82-0344294","61589ID1780001","Bronze Connect East","61589ID178",,"IDN003","IDS003","IDF001","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1780001-03","Limited Cost Sharing Plan Variation","60.19%","0.601943850517273","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,417","$270","$0","$0","15"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1980001","Bronze Choice 3000","61589ID198",,"IDN001","IDS001","IDF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1980001-01","Standard Bronze On Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","Individual","No","82-0344294","61589ID1680001","Platinum Connect Southwest","61589ID168",,"IDN002","IDS002","IDF002","New","POS","Platinum","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","5","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1680001-01","Standard Platinum On Exchange Plan","88.20%","0.832297086715698","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$550","$1,100","0%",,,,"$550","$1,100","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,"$550","$270","$0","$0","$550","$490","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2030001","Bronze Connect Southwest 3000","61589ID203",,"IDN002","IDS002","IDF004","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2030001-00","Standard Bronze Off Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2030001","Bronze Connect Southwest 3000","61589ID203",,"IDN002","IDS002","IDF004","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2030001-01","Standard Bronze On Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2080001","Bronze Connect East 3000","61589ID208",,"IDN003","IDS003","IDF004","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2080001-00","Standard Bronze Off Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","3","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2080001","Bronze Connect East 3000","61589ID208",,"IDN003","IDS003","IDF004","New","POS","Bronze","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2080001-01","Standard Bronze On Exchange Plan","59.7%","0","No","No","No","100%",,"$6,000","$12,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"$3,000","$6,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,"$3,000","$70","$1,290","$0","$2,400","$400","$0","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1970001","Silver Choice 2000","61589ID197",,"IDN001","IDS001","IDF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1970001-00","Standard Silver Off Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1690001","Bronze H.S.A. Saver","61589ID169",,"IDN001","IDS001","IDF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1690001-00","Standard Bronze Off Exchange Plan","60.38%","0.603818774223328","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$5,000","$70","$0","$0","$5,000","$120","$0","$0","4"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1690001","Bronze H.S.A. Saver","61589ID169",,"IDN001","IDS001","IDF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1690001-01","Standard Bronze On Exchange Plan","60.38%","0.603818774223328","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$5,000","$70","$0","$0","$5,000","$120","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID1970001","Silver Choice 2000","61589ID197",,"IDN001","IDS001","IDF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1970001-01","Standard Silver On Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2140001","Silver Point 2000","61589ID214",,"IDN005","IDS001","IDF007","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2140001-00","Standard Silver Off Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","6"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1690001","Bronze H.S.A. Saver","61589ID169",,"IDN001","IDS001","IDF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1690001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL028","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NN/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NN/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280003-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","8"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","8"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310002","Pathfinder POS 1750/3500 30% 5500/11000 RX3","20129IL031","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QK/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QK/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310002-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,750","$500","$200","$80","11"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300002-03","Limited Cost Sharing Plan Variation","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","11"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270001","Guide HMO QHDHP 1750/3500 20% 5500/11000 RX2","20129IL027","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270001-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","12"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,800","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","12"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270001","Guide HMO QHDHP 1750/3500 20% 5500/11000 RX2","20129IL027","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270001-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","13"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,800","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","13"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0070004","Bronze Deductible Only PPO HSA Eligible Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0070004","Bronze Deductible Only PPO HSA Eligible Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","5","35670","IL","Individual","No","75-1296086","35670IL0060005","Catastrophic 100% PPO Plan","35670IL006",,"ILN001","ILS001","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","5","35670","IL","Individual","No","75-1296086","35670IL0060005","Catastrophic 100% PPO Plan","35670IL006",,"ILN001","ILS001","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","5","35670","IL","Individual","No","75-1296086","35670IL0070005","Catastrophic 100% PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72243","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","5","35670","IL","Individual","No","75-1296086","35670IL0070005","Catastrophic 100% PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72243","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790002","Blue Choice Gold PPO 002","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840006","BlueCare Dental 1D","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$64.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840006-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold 002","36096IL077",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790001","Blue Choice Gold PPO 001","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0070004","Bronze Deductible Only PPO HSA Eligible Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0070004","Bronze Deductible Only PPO HSA Eligible Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72214","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820003","Blue Precision Bronze HMO 003","36096IL082",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820003-01","Standard Bronze On Exchange Plan",,"0.615997314453125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","Individual","No","36-1236610","36096IL0810003","Blue Precision Bronze HMO 003","36096IL081",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","Individual","No","36-1236610","36096IL0810003","Blue Precision Bronze HMO 003","36096IL081",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810003-03","Limited Cost Sharing Plan Variation",,"0.615997314453125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","Individual","No","36-1236610","36096IL0760010","Blue Security PPO 010","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4A/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4A/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RXDed","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4A/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4A/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RXDed","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UR/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UR/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RXDed","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UR/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UR/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4A/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4A/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300001-03","Limited Cost Sharing Plan Variation","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800002","Blue Choice Gold PPO 002","36096IL080",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800004","Blue Choice Silver PPO 004","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770005","Blue PPO Bronze 005","36096IL077",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840003","BlueCare Dental 4 Kids 1A","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380018","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380018-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800001","Blue Choice Gold PPO 001","36096IL080",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270002","Guide HMO QHDHP 1500/3000 30% 5250/10500 RX3","20129IL027","7740283974","ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270002-00","Standard Silver Off Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,600","$200","$1,500","$600","$200","$80","14"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","4","72547","IL","Individual","No","06-6033492","72547IL0070004","Aetna AdvantagePlus 5500 PD","72547IL007",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070004-00","Standard Bronze Off Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","4","72547","IL","Individual","No","06-6033492","72547IL0070004","Aetna AdvantagePlus 5500 PD","72547IL007",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070004-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","4","72547","IL","Individual","No","06-6033492","72547IL0070004","Aetna AdvantagePlus 5500 PD","72547IL007",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770021","Blue PPO Silver 021","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770021-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2140001","Silver Point 2000","61589ID214",,"IDN005","IDS001","IDF007","New","POS","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2140001-01","Standard Silver On Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1690001","Bronze H.S.A. Saver","61589ID169",,"IDN001","IDS001","IDF003","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1690001-03","Limited Cost Sharing Plan Variation","60.38%","0.603818774223328","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$5,000","$70","$0","$0","$5,000","$120","$0","$0","7"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1700001","Covered Choice","61589ID170",,"IDN001","IDS001","IDF001","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1700001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2020001","Silver Connect Southwest 2000","61589ID202",,"IDN002","IDS002","IDF007","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2020001-00","Standard Silver Off Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","8"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2020001","Silver Connect Southwest 2000","61589ID202",,"IDN002","IDS002","IDF007","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2020001-01","Standard Silver On Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1700001","Covered Choice","61589ID170",,"IDN001","IDS001","IDF001","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1700001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","9"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1900001","Covered Connect Southwest","61589ID190",,"IDN002","IDS002","IDF001","New","POS","Catastrophic","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1900001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2070001","Silver Connect East 2000","61589ID207",,"IDN003","IDS003","IDF007","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2070001-00","Standard Silver Off Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","10"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1900001","Covered Connect Southwest","61589ID190",,"IDN002","IDS002","IDF001","New","POS","Catastrophic","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1900001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","SHOP (Small Group)","No","82-0344294","61589ID2070001","Silver Connect East 2000","61589ID207",,"IDN003","IDS003","IDF007","New","POS","Silver","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Small-Group-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID2070001-01","Standard Silver On Exchange Plan","70.60%","0","No","No","No","100%",,"$6,350","$12,700",,,"$8,350","$16,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$70","$1,590","$0","$1,400","$700","$0","$0","11"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1910001","Covered Connect East","61589ID191",,"IDN003","IDS003","IDF001","New","POS","Catastrophic","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1910001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","12"
"2014","ID","61589","SERFF","11","2014-01-22 11:51:12","4","61589","ID","Individual","No","82-0344294","61589ID1910001","Covered Connect East","61589ID191",,"IDN003","IDS003","IDF001","New","POS","Catastrophic","Yes","Both","No","Yes","Audiologist, Cardiovascular Disease, Cardiovascular Surgery, Child Psychiatry, Chiropractor, Colon and Rectal Surgery, Dermatology, Endocrinology, General Surgery, Gynecology, Gynecology Oncology, Hand Surgery, Infectious Diseases, Lic Marriage/Family Therapist, Licensed Prof Counselor, Maternal & Fetal Medicine, Mental Health Clinician, Neonatology, Nephrology, Neurological Surgery, Neurology, Occupational Therapist, Ophthalmology, Optometrist, Orthopedic (non-surgical), Orthopedic Surgery, Otolaryngology (ENT), Pediatric Cardiology, Physical Medicine & Rehab, Physical Therapist, Plastic Surgery, Podiatry - Surgical Chiropody, Psychiatric Social Worker, Psychiatry, Psychologist, Pulmonary Disease, Social Worker � Clinical, Speech Therapist, Surgery Trauma, Thoracic Surgery, Urology, Vascular Surgery.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","The benefits available under this Contract are also available to Members traveling or living outside the United States. The Inpatient Notification and Prior Authorization requirements will apply.","Yes","In these situations, the Enrollee may be responsible for the difference between the amount that the non-participating healthcare Provider bills and the payment BCI will make for the covered services as set forth","Yes","www.bcidaho.com/sbc/","https://prod_saml_sp_ffm.bcidaho.com/bci/saml/sp","www.bcidaho.com/Blue-Cross-Of-Idaho-Individual-Products.pdf","www.bcidaho.com/bci_v2/pharmacy_info/General_Formulary.aspx?id","61589ID1910001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$4,950","$90","$0","$0","13"
"2014","ID","88257","SERFF","1","2013-08-01 21:15:43","1","88257","ID","SHOP (Small Group)","Yes","93-0242990","88257ID0040001","EHB Low PPO","88257ID004",,"IDN001","IDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.76",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"88257ID0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ID","88257","SERFF","1","2013-08-01 21:15:43","1","88257","ID","SHOP (Small Group)","Yes","93-0242990","88257ID0030002","EHB High Passive","88257ID003",,"IDN001","IDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$49.92",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"88257ID0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020001",,"18715IL0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","Individual","Yes","75-1233841","18715IL0010001","Dentegra Dental PPO Children's Plan 70","18715IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010001",,"18715IL0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020001",,"18715IL0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","Individual","Yes","75-1233841","18715IL0010001","Dentegra Dental PPO Children's Plan 70","18715IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010001",,"18715IL0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","Individual","Yes","75-1233841","18715IL0010002","Dentegra Dental PPO Children's Plan 85","18715IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010002",,"18715IL0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","SHOP (Small Group)","Yes","75-1233841","18715IL0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","18715IL002",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/il/18715il0020002",,"18715IL0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","18715","SERFF","5","2014-01-22 11:51:12","1","18715","IL","Individual","Yes","75-1233841","18715IL0010002","Dentegra Dental PPO Children's Plan 85","18715IL001",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.25",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/il/18715il0010002",,"18715IL0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0280001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RXDed","20129IL028","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0280001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","20129IL030","7740283974","ILN001","ILS001","ILF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4A/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4A/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270003","Guide HMO 3150/6350 40% 6350/12700 RX3","20129IL027","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26C/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26C/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,200","$200","$3,150","$400","$70","$80","7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-00","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,300","$200","$1,800","$100","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-05","87% AV Level Silver Plan","86.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,000","$22,000","$12,850","$25,700","$150","$300","20%",,,,"$4,800","$9,600","$4,950","$9,900","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$150","$0","$1,300","$200","$150","$100","$200","$80","9"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","3","20129","IL","Individual","No","37-1260731","20129IL0340003","Pathfinder POS 30/60 2400/4800/30% 5500/11000 Rx5","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3O/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3O/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340003-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,000","$22,000","$12,850","$25,700","$0","$0","30%",,,,"$4,800","$9,600","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$200","$200","$0","$100","$20","$80","10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-06","94% AV Level Silver Plan","93.58%","0.935783624649048","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820003","Blue Precision Bronze HMO 003","36096IL082",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820003-00","Standard Bronze Off Exchange Plan",,"0.615997314453125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","Individual","No","36-1236610","36096IL0810003","Blue Precision Bronze HMO 003","36096IL081",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810003-00","Standard Bronze Off Exchange Plan",,"0.615997314453125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","4","36096","IL","Individual","No","36-1236610","36096IL0810003","Blue Precision Bronze HMO 003","36096IL081",,"ILN003","ILS003","ILF009","New","HMO","Bronze","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810003-01","Standard Bronze On Exchange Plan",,"0.615997314453125","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270002","Guide HMO QHDHP 1500/3000 30% 5250/10500 RX3","20129IL027","7740283974","ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270002-01","Standard Silver On Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,600","$200","$1,500","$600","$200","$80","15"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-03","Limited Cost Sharing Plan Variation","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,800","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","15"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-04","73% AV Level Silver Plan","72.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"$10,500","$21,000","$14,400","$28,800",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,800","$1,750","$10","$1,000","$200","$1,750","$400","$100","$80","16"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,500","$21,000","$12,200","$24,400",,,,,,,,,,,,,,,,,,,,,"$450","$900","15%",,,,"$3,500","$7,000","$3,950","$7,900","$450","$10","$1,000","$200","$450","$600","$200","$80","17"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0300003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 RX2","20129IL030","7740283974","ILN001","ILS001","ILF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3Q/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3Q/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0300003-06","94% AV Level Silver Plan","93.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,500","$21,000","$12,200","$24,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$10","$300","$200","$0","$600","$50","$80","18"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-00","Standard Silver Off Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,300","$700","$0","$80","19"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-01","Standard Silver On Exchange Plan","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,300","$700","$0","$80","20"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-03","Limited Cost Sharing Plan Variation","70.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,300","$700","$0","$80","22"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0340002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","20129IL034","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Y/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Y/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340002-04","73% AV Level Silver Plan","72.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,400","$6,800",,,"$11,500","$23,000","$14,900","$29,800","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,500","$200","$1,300","$700","$0","$80","23"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","1","20129","IL","Individual","No","37-1260731","20129IL0290001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","20129IL029","7740283974","ILN001","ILS001","ILF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290001-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$10","$300","$200","$0","$600","$50","$80","32"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","Individual","No","37-1260731","20129IL0340001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","20129IL034","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3M/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3M/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340001-00","Standard Gold Off Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,100","$200","$900","$600","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 RX5","20129IL031","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6MG/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6MG/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310003-00","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0310003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 RX5","20129IL031","7740283974","ILN001","ILS001","ILF003","New","POS","Silver","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6MG/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6MG/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0310003-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","0%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","Individual","No","37-1260731","20129IL0340001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","20129IL034","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3M/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3M/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340001-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,100","$200","$900","$600","$0","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","Individual","No","37-1260731","20129IL0340001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","20129IL034","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3M/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3M/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","SHOP (Small Group)","No","37-1260731","20129IL0270003","Guide HMO 3150/6350 40% 6350/12700 RX3","20129IL027","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","Yes","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26C/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26C/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0270003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,200","$200","$3,150","$400","$70","$80","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","2","20129","IL","Individual","No","37-1260731","20129IL0340001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","20129IL034","7740283974","ILN001","ILS001","ILF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3M/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3M/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0340001-03","Limited Cost Sharing Plan Variation","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,100","$200","$900","$600","$0","$80","7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","4","20129","IL","Individual","No","37-1260731","20129IL0290002","Guide HMO 3150/6300 40% 6350/12700 RX3","20129IL029","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290002-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,200","$200","$3,150","$400","$70","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","4","20129","IL","Individual","No","37-1260731","20129IL0290002","Guide HMO 3150/6300 40% 6350/12700 RX3","20129IL029","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290002-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,200","$200","$3,150","$400","$70","$80","5"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","4","20129","IL","Individual","No","37-1260731","20129IL0290002","Guide HMO 3150/6300 40% 6350/12700 RX3","20129IL029","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","4","20129","IL","Individual","No","37-1260731","20129IL0290002","Guide HMO 3150/6300 40% 6350/12700 RX3","20129IL029","7740283974","ILN001","ILS001","ILF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3G/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3G/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290002-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,200","$200","$3,150","$400","$70","$80","7"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","5","20129","IL","Individual","No","37-1260731","20129IL0290003","Guide HMO 6350/12700 0% 6350/12700 RxDed","20129IL029","7740283974","ILN001","ILS001","ILF004","New","HMO","Catastrophic","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26W/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26W/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$567","$0","$200","$700","$3","$0","$80","4"
"2014","IL","20129","SERFF","10","2014-01-22 11:51:12","5","20129","IL","Individual","No","37-1260731","20129IL0290003","Guide HMO 6350/12700 0% 6350/12700 RxDed","20129IL029","7740283974","ILN001","ILS001","ILF004","New","HMO","Catastrophic","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26W/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26W/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","20129IL0290003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,200","$567","$0","$200","$700","$3","$0","$80","5"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0060001","Gold $10 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72200","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0060001","Gold $10 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72200","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0060001","Gold $10 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72200","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0060001","Gold $10 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72200","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0070001","Gold $5 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72215","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0070001","Gold $5 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72215","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0070001","Gold $5 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72215","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","1","35670","IL","Individual","No","75-1296086","35670IL0070001","Gold $5 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72215","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-00","Standard Silver Off Exchange Plan","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-01","Standard Silver On Exchange Plan","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-03","Limited Cost Sharing Plan Variation","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-04","73% AV Level Silver Plan","73.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-05","87% AV Level Silver Plan","86.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0060002","Silver $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72203","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-00","Standard Silver Off Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","2","35670","IL","Individual","No","75-1296086","35670IL0070002","Silver $10 Copay PPO Carelink from Coventry","35670IL007",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","ALL","See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72218","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppocarelinkmo","http://c1formularyhix.com","35670IL0070002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0060003","Bronze $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72210","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060003-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","3","35670","IL","Individual","No","75-1296086","35670IL0060003","Bronze $15 Copay PPO Plan","35670IL006",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72210","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060003-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Bronze Deductible Only PPO HSA Eligible Plan","35670IL006",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72227","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","35670","SERFF","4","2013-09-17 21:55:00","4","35670","IL","Individual","No","75-1296086","35670IL0060004","Bronze Deductible Only PPO HSA Eligible Plan","35670IL006",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,"See Certificate of Coverage for List of Exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both Emergent and Elective","Yes","Both Emergent and Elective","No","http://coventryhealthcare.com/il72227","https://sspprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppomo","http://c1formularyhix.com","35670IL0060004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770005","Blue PPO Bronze 005","36096IL077",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840003","BlueCare Dental 4 Kids 1A","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","Yes","36-1236610","36096IL0830003","BlueCare Dental 4 Kids 1A","36096IL083",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","1","72547","IL","Individual","No","06-6033492","72547IL0070001","Aetna Advantage 5750 PD","72547IL007",,"ILN001","ILS001","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","1","72547","IL","Individual","No","06-6033492","72547IL0070001","Aetna Advantage 5750 PD","72547IL007",,"ILN001","ILS001","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070001-03","Limited Cost Sharing Plan Variation","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","2","72547","IL","Individual","No","06-6033492","72547IL0070002","Aetna Advantage 6350","72547IL007",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","2","72547","IL","Individual","No","06-6033492","72547IL0070002","Aetna Advantage 6350","72547IL007",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","2","72547","IL","Individual","No","06-6033492","72547IL0070002","Aetna Advantage 6350","72547IL007",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800009","Blue Choice Silver PPO 009","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800009-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380014-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760002","Blue PPO Gold 002","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760002","Blue PPO Gold 002","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760002","Blue PPO Gold 002","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760002","Blue PPO Gold 002","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO 002","36096IL082",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820002-00","Standard Silver Off Exchange Plan","70.53%","0.705312609672546","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840007","BlueCare Dental 1E","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$83.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840007-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810001","Blue Precision Gold HMO 001","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820002","Blue Precision Silver HMO 002","36096IL082",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820002-01","Standard Silver On Exchange Plan","70.53%","0.705312609672546","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380037","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380037-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380037","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380037-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380038","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380038-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380038","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380038-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380038","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380038-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380038","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN003","ILS004","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380038-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380025","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380025-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380025","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380025-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380026-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental 1A","36096IL083",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840001","BlueCare Dental 1A","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840001","BlueCare Dental 1A","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","Yes","36-1236610","36096IL0830001","BlueCare Dental 1A","36096IL083",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770002","Blue PPO Gold 002","36096IL077",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,000","20%",,,,"$3,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790001","Blue Choice Gold PPO 001","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840002","BlueCare Dental 1B","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental 1B","36096IL083",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold 001","36096IL077",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790001","Blue Choice Gold PPO 001","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790001","Blue Choice Gold PPO 001","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770001","Blue PPO Gold 001","36096IL077",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840002","BlueCare Dental 1B","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","Yes","36-1236610","36096IL0830002","BlueCare Dental 1B","36096IL083",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790002","Blue Choice Gold PPO 002","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver 004","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840006","BlueCare Dental 1D","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$64.89",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840006-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770004","Blue PPO Silver 004","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver 003","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840009","BlueCare Dental 1G","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840009-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760005","Blue PPO Bronze 005","36096IL076",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760006","Blue PPO Bronze 006","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380030","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380030-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"62"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380030","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380030-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN004","ILS003","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380027-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380001","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790002","Blue Choice Gold PPO 002","36096IL079",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770003","Blue PPO Silver 003","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800001","Blue Choice Gold PPO 001","36096IL080",,"ILN002","ILS002","ILF005","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-04","73% AV Level Silver Plan","73.90%","0.738598048686981","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","30%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-05","87% AV Level Silver Plan","87.90%","0.880677878856659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$5,100","$10,200","$6,800","$13,600",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%",,,,"$600","$1,200","$800","$1,600",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-06","94% AV Level Silver Plan","94.70%","0.947102963924408","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,800","$3,600","$2,400","$4,800",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$300","$600","$400","$800",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010003","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $12000 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010003-00","Standard Bronze Off Exchange Plan","59.98%","0.599765002727509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"15"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010003","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $12000 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010003-01","Standard Bronze On Exchange Plan","59.98%","0.599765002727509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"16"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010003","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $12000 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver 020","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770020-00","Standard Silver Off Exchange Plan","71.50%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","Individual","No","36-1236610","36096IL0760010","Blue Security PPO 010","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380017-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380018","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380018-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800004","Blue Choice Silver PPO 004","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790003","Blue Choice Silver PPO 003","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800003","Blue Choice Silver PPO 003","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800003","Blue Choice Silver PPO 003","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0790004","Blue Choice Silver PPO 004","36096IL079",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760001","Blue PPO Gold 001","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760001","Blue PPO Gold 001","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760001","Blue PPO Gold 001","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760001","Blue PPO Gold 001","36096IL076",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"36"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760003","Blue PPO Silver 003","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","1","36096","IL","Individual","No","36-1236610","36096IL0760004","Blue PPO Silver 004","36096IL076",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"36"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380017-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380017-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380018","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380018-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380018","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380018-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380013","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380014-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","1","72547","IL","Individual","No","06-6033492","72547IL0070001","Aetna Advantage 5750 PD","72547IL007",,"ILN001","ILS001","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070001-00","Standard Bronze Off Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","1","72547","IL","Individual","No","06-6033492","72547IL0070001","Aetna Advantage 5750 PD","72547IL007",,"ILN001","ILS001","ILF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070001-01","Standard Bronze On Exchange Plan","60.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","0%",,,,"$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790005","Blue Choice Bronze PPO 005","36096IL079",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze 006","36096IL077",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790005","Blue Choice Bronze PPO 005","36096IL079",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids 1B","36096IL083",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840004","BlueCare Dental 4 Kids 1B","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","Yes","36-1236610","36096IL0830004","BlueCare Dental 4 Kids 1B","36096IL083",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsil.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsil.com/coverage/individual/on-exchange/dental/",,"36096IL0830004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840004","BlueCare Dental 4 Kids 1B","36096IL084",,"ILN004","ILS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770006","Blue PPO Bronze 006","36096IL077",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790005","Blue Choice Bronze PPO 005","36096IL079",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790005-03","Limited Cost Sharing Plan Variation",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800005","Blue Choice Bronze PPO 005","36096IL080",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800005-00","Standard Bronze Off Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790006","Blue Choice Bronze PPO 006","36096IL079",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790006","Blue Choice Bronze PPO 006","36096IL079",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800005","Blue Choice Bronze PPO 005","36096IL080",,"ILN002","ILS002","ILF008","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790006","Blue Choice Bronze PPO 006","36096IL079",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800006","Blue Choice Bronze PPO 006","36096IL080",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800006","Blue Choice Bronze PPO 006","36096IL080",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0790006","Blue Choice Bronze PPO 006","36096IL079",,"ILN002","ILS002","ILF007","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0790006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760005","Blue PPO Bronze 005","36096IL076",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760005","Blue PPO Bronze 005","36096IL076",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760005","Blue PPO Bronze 005","36096IL076",,"ILN001","ILS001","ILF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760006","Blue PPO Bronze 006","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760006","Blue PPO Bronze 006","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","2","36096","IL","Individual","No","36-1236610","36096IL0760006","Blue PPO Bronze 006","36096IL076",,"ILN001","ILS001","ILF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0760006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810001","Blue Precision Gold HMO 001","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810001-00","Standard Gold Off Exchange Plan","80.74%","0.807351887226105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO 001","36096IL082",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820001-00","Standard Gold Off Exchange Plan","80.74%","0.807351887226105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840005","BlueCare Dental 1C","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$83.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840005-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840005","BlueCare Dental 1C","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$83.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840005-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0820001","Blue Precision Gold HMO 001","36096IL082",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0820001-01","Standard Gold On Exchange Plan","80.74%","0.807351887226105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810001","Blue Precision Gold HMO 001","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810001-01","Standard Gold On Exchange Plan","80.74%","0.807351887226105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840007","BlueCare Dental 1E","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$83.91",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840007-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$25","$75","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810001","Blue Precision Gold HMO 001","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Gold","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810001-03","Limited Cost Sharing Plan Variation","80.74%","0.807351887226105","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-00","Standard Silver Off Exchange Plan","70.53%","0.705312609672546","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840008","BlueCare Dental 1F","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840008-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-01","Standard Silver On Exchange Plan","70.53%","0.705312609672546","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","SHOP (Small Group)","Yes","36-1236610","36096IL0840008","BlueCare Dental 1F","36096IL084",,"ILN004","ILS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$72.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,,"http://www.bcbsil.com/employer/products/on-exchange/dental/",,"36096IL0840008-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-03","Limited Cost Sharing Plan Variation","70.53%","0.705312609672546","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-04","73% AV Level Silver Plan","72.76%","0.727636575698853","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","3","36096","IL","Individual","No","36-1236610","36096IL0810002","Blue Precision Silver HMO 002","36096IL081",,"ILN003","ILS003","ILF006","New","HMO","Silver","Yes","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsil.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/IL/exchange_referred","http://www.bcbsil.com/coverage/individual/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0810002-05","87% AV Level Silver Plan","86.52%","0.865242123603821","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$3,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-06","94% AV Level Silver Plan",,"0.935785233974457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$475","$950",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$475","$950","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-00","Standard Silver Off Exchange Plan","68.35%","0.683516979217529","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080003","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF012","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $6000 Deductible; MOOP is $18750","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0080003-00","Standard Bronze Off Exchange Plan","61.77%","0.678517520427704","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080003","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF012","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $6000 Deductible; MOOP is $18750","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0080003-01","Standard Bronze On Exchange Plan","61.77%","0.678517520427704","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-01","Standard Silver On Exchange Plan","68.35%","0.683516979217529","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010002","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010002-03","Limited Cost Sharing Plan Variation","68.35%","0.683516979217529","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-00","Standard Silver Off Exchange Plan","69.80%","0.695430159568787","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-01","Standard Silver On Exchange Plan","69.80%","0.695430159568787","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","10","79763","IL","Individual","No","90-0962741","79763IL0040003","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $15000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070001","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070001","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070001-03","Limited Cost Sharing Plan Variation","78.13%","0.776721179485321","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%","$500","$1,000","25%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-00","Standard Silver Off Exchange Plan","68.00%","0.671419560909271","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","30%","$4,250","$8,500","30%","$12,750","$25,500","$17,000","$34,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-01","Standard Silver On Exchange Plan","68.00%","0.671419560909271","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","30%","$4,250","$8,500","30%","$12,750","$25,500","$17,000","$34,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","75159","SERFF","1","2013-08-01 21:15:43","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0040002","EHB High PPO","75159IL004",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.16",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"75159IL0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","75159","SERFF","1","2013-08-01 21:15:43","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0040001","EHB Low PPO","75159IL004",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.48",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"75159IL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","75159","SERFF","1","2013-08-01 21:15:43","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0030002","EHB High Passive","75159IL003",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.52",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"75159IL0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770020","Blue PPO Silver 020","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770020-01","Standard Silver On Exchange Plan","71.50%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800008","Blue Choice Silver PPO 008","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800008-00","Standard Silver Off Exchange Plan","71.50%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","5","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800008","Blue Choice Silver PPO 008","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800008-01","Standard Silver On Exchange Plan","71.50%","0.715575575828552","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0770021","Blue PPO Silver 021","36096IL077",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0770021-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","36096","SERFF","10","2014-01-22 11:51:12","6","36096","IL","SHOP (Small Group)","No","36-1236610","36096IL0800009","Blue Choice Silver PPO 009","36096IL080",,"ILN002","ILS002","ILF006","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","This plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsil.com/employer/products/on-exchange/",,"http://www.bcbsil.com/employer/products/on-exchange/","www.bcbsil.com/member/rx_drugs.html","36096IL0800009-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","SHOP (Small Group)","Yes","47-0397286","46552IL0030001","Renaissance Group Dental PPO, EHB Certified","46552IL003",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","Individual","Yes","47-0397286","46552IL0010001","Delta Dental Individual PPO, EHB Certified","46552IL001",,"ILN002","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","SHOP (Small Group)","Yes","47-0397286","46552IL0030002","Renaissance Group Dental PPO, EHB Certified","46552IL003",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","Individual","Yes","47-0397286","46552IL0010002","Delta Dental Individual PPO, EHB Certified","46552IL001",,"ILN002","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.58",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","Individual","Yes","47-0397286","46552IL0020001","Renaissance Individual Dental PPO, EHB Certified","46552IL002",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","46552","SERFF","1","2013-08-01 21:15:43","1","46552","IL","Individual","Yes","47-0397286","46552IL0020002","Renaissance Individual Dental PPO, EHB Certified","46552IL002",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46552IL0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380004","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN001","ILS001","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380005","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380005-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380005","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380005","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380005","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380006","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380006-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380006","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380006-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380006","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380006","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN001","ILS001","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380006-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380016","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN002","ILS002","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380016-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380017","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN002","ILS002","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380017-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-03","Limited Cost Sharing Plan Variation","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-06","94% AV Level Silver Plan","94.00%","0.939659416675568","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,800","$3,600","$2,400","$4,800",,,,,,,,,,,,,,,,,,,,,"$50","$100","10%",,,,"$150","$300","$200","$400",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030001","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030001-03","Limited Cost Sharing Plan Variation","79.08%","0.789864182472229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140002","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0140002-01","Standard Silver On Exchange Plan","69.41%","0.686968863010406","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%","$1,750","$3,500","40%","$5,250","$10,500","$7,000","$14,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-03","Limited Cost Sharing Plan Variation","69.80%","0.695430159568787","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-04","73% AV Level Silver Plan","73.80%","0.736087143421173","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$15,600","$31,200","$20,800","$41,600",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","25%",,,,"$5,100","$10,200","$6,800","$13,600",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-05","87% AV Level Silver Plan","87.40%","0.876021981239319","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$6,750","$13,500","$9,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$300","$600","$400","$800",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030002","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $7500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030002-06","94% AV Level Silver Plan","94.80%","0.947725474834442","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$1,950","$3,900","$2,600","$5,200",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030003","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $18750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030003-00","Standard Bronze Off Exchange Plan","61.88%","0.666066527366638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","40%",,,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,"15"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030003","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $18750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030003-01","Standard Bronze On Exchange Plan","61.88%","0.666066527366638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","40%",,,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,"16"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380040","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN003","ILS004","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380040-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380041","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380041-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380041","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380041-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380041","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380041-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380041","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380041-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380042","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380042-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380042","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380042-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380042","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380042-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380042","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN003","ILS004","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380042-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-00","Standard Silver Off Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"51"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"52"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"53"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380028","Humana Connect Silver 4600/6300 Plan","58288IL038",,"ILN004","ILS003","ILF003","New","HMO","Silver","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104154","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058160","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380028-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380029-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380029-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380029-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"58"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380029","Humana Connect Gold 2500/3500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Gold","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104180","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058108","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380029-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"59"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380030","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380030-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"60"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","1","58288","IL","Individual","No","61-1013183","58288IL0380030","Humana Connect Platinum 1000/1500 Plan","58288IL038",,"ILN004","ILS003","ILF004","New","HMO","Platinum","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104206","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058134","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380030-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"61"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380003","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380003","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-00","Standard Silver Off Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-01","Standard Silver On Exchange Plan","68.19%","0.681853055953979","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$4,250","$8,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380003","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380003","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN001","ILS001","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN002","ILS002","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380015-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN002","ILS002","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380015-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN002","ILS002","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380015","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN002","ILS002","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380015-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080002","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0080002-01","Standard Silver On Exchange Plan","68.35%","0.75461882352829","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010003","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $12000 Deductible; MOOP is $18750","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010003-03","Limited Cost Sharing Plan Variation","59.98%","0.599765002727509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"18"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130001","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0130001-00","Standard Gold Off Exchange Plan","78.47%","0.778931796550751","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%","$750","$1,500","25%","$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0100001","Land of Lincoln National Complete PPO Plan","79763IL010",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $13000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Complete-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0100001-00","Standard Gold Off Exchange Plan","79.08%","0.789864182472229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020001","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020001-00","Standard Gold Off Exchange Plan","78.16%","0.780481815338135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020001","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020001-01","Standard Gold On Exchange Plan","78.16%","0.780481815338135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130001","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0130001-01","Standard Gold On Exchange Plan","78.47%","0.778931796550751","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%","$750","$1,500","25%","$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0100001","Land of Lincoln National Complete PPO Plan","79763IL010",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $13000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Complete-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0100001-01","Standard Gold On Exchange Plan","79.08%","0.789864182472229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020001","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130002","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0130002-00","Standard Silver Off Exchange Plan","69.08%","0.683248817920685","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%","$2,000","$4,000","40%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"6"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380039","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN003","ILS004","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380039-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380039","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN003","ILS004","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380039-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380039","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN003","ILS004","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380039-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380039","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN003","ILS004","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380039-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN004","ILS003","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380027-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN004","ILS003","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380027-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","2","58288","IL","Individual","No","61-1013183","58288IL0380027","Humana Connect Bronze 4850/6350 Plan","58288IL038",,"ILN004","ILS003","ILF002","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104141","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2058069","http://apps.humana.com/marketing/documents.asp?file=2067403","58288IL0380027-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380001","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380002","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380002-00","Standard Bronze Off Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380002","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380002-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380002","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380002","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN001","ILS001","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380002-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380013","Humana Connect Basic 6350/6350 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Catastrophic","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104115","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057393","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380014-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380014","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN002","ILS002","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380026-01","Standard Bronze On Exchange Plan","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380026-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","IL","58288","SERFF","3","2013-09-02 14:52:56","3","58288","IL","Individual","No","61-1013183","58288IL0380026","Humana Connect Bronze 6300/6300 Plan","58288IL038",,"ILN004","ILS003","ILF001","New","HMO","Bronze","Yes","Both","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104128","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057458","http://apps.humana.com/marketing/documents.asp?file=2067338","58288IL0380026-03","Limited Cost Sharing Plan Variation","58.16%","0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","1","60600","IL","SHOP (Small Group)","Yes","36-2612058","60600IL0030002","Kids Dental Wellness Plus","60600IL003",,"ILN001","ILS001",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$30.09",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes",,,,,"60600IL0030002-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","1","60600","IL","Individual","Yes","36-2612058","60600IL0010001","Kids Dental Wellness Plus","60600IL001",,"ILN001","ILS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","1","60600","IL","Individual","Yes","36-2612058","60600IL0010001","Kids Dental Wellness Plus","60600IL001",,"ILN001","ILS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","1","60600","IL","Individual","Yes","36-2612058","60600IL0010002","Kids Dental Wellness","60600IL001",,"ILN001","ILS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","1","60600","IL","Individual","Yes","36-2612058","60600IL0010002","Kids Dental Wellness","60600IL001",,"ILN001","ILS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Benefits; Must See Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","2","60600","IL","Individual","Yes","36-2612058","60600IL0010003","Family Dental Wellness Plus","60600IL001",,"ILN001","ILS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergencies Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010003-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","2","60600","IL","Individual","Yes","36-2612058","60600IL0010003","Family Dental Wellness Plus","60600IL001",,"ILN001","ILS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.58",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergencies Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010003-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","2","60600","IL","Individual","Yes","36-2612058","60600IL0010004","Family Dental Wellness","60600IL001",,"ILN001","ILS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergencies Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010004-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","60600","SERFF","4","2013-09-19 10:34:04","2","60600","IL","Individual","Yes","36-2612058","60600IL0010004","Family Dental Wellness","60600IL001",,"ILN001","ILS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Emergencies Only","Yes","All Benefits; Must see Delta Dental PPO Provider","Yes","www.deltadentalilexchange.com/dental-plans","https://auth.deltadentalil.com/sp/ACS.saml2","www.deltadentalilexchange.com/dental-plans",,"60600IL0010004-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","Yes","39-1263473","68303IL0690001","Humana Dental Smart Choice","68303IL069",,"ILN002","ILS002",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.50",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084316",,"68303IL0690001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-04","73% AV Level Silver Plan","72.51%","0.725123465061188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$25,000","$50,000","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-05","87% AV Level Silver Plan","86.33%","0.863307356834412","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$25,000","$50,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680004","Humana National Preferred Silver 4250/6250 Plan","68303IL068",,"ILN001","ILS001","ILF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104271","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057965","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680004-06","94% AV Level Silver Plan","93.72%","0.937241017818451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$25,000","$50,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$8,500","$17,000","Not Applicable","Not Applicable","$250","$500","50%",,,,"$750","$1,500","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680006","Humana National Preferred Gold 2500/3500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104349","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057562","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680006-00","Standard Gold Off Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680006","Humana National Preferred Gold 2500/3500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104349","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057562","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680006-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680006","Humana National Preferred Gold 2500/3500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104349","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057562","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680006","Humana National Preferred Gold 2500/3500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104349","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057562","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680006-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$14,000","$28,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680007","Humana National Preferred Platinum 1000/1500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104375","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057601","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680007-00","Standard Platinum Off Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680007","Humana National Preferred Platinum 1000/1500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104375","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057601","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680007-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680007","Humana National Preferred Platinum 1000/1500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104375","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057601","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","1","68303","IL","Individual","No","39-1263473","68303IL0680007","Humana National Preferred Platinum 1000/1500 Plan","68303IL068",,"ILN001","ILS001","ILF004","New","PPO","Platinum","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104375","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057601","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680007-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","32%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680001","Humana National Preferred Basic 6350/6350 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104219","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057549","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680001","Humana National Preferred Basic 6350/6350 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104219","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057549","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680002","Humana National Preferred Bronze 6300/6300 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104232","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057406","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680002-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680002","Humana National Preferred Bronze 6300/6300 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104232","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057406","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680002","Humana National Preferred Bronze 6300/6300 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104232","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057406","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680002","Humana National Preferred Bronze 6300/6300 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104232","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057406","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$25,200","$50,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$12,600","$25,200","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-00","Standard Silver Off Exchange Plan",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-01","Standard Silver On Exchange Plan",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"12"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-03","Limited Cost Sharing Plan Variation",,"0.680402517318726","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,650","$7,300",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,650","$7,300","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","2","68303","IL","Individual","No","39-1263473","68303IL0680005","Humana National Preferred Silver 3650/3650 Plan","68303IL068",,"ILN001","ILS001","ILF001","New","PPO","Silver","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104336","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057978","http://apps.humana.com/marketing/documents.asp?file=2067338","68303IL0680005-04","73% AV Level Silver Plan",,"0.721818149089813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,920","$5,840",,,"$14,600","$29,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,920","$5,840","0%",,,,"$7,300","$14,600","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","3","68303","IL","Individual","No","39-1263473","68303IL0680003","Humana National Preferred Bronze 4850/6350 Plan","68303IL068",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104245","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057523","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680003-00","Standard Bronze Off Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","3","68303","IL","Individual","No","39-1263473","68303IL0680003","Humana National Preferred Bronze 4850/6350 Plan","68303IL068",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104245","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057523","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","3","68303","IL","Individual","No","39-1263473","68303IL0680003","Humana National Preferred Bronze 4850/6350 Plan","68303IL068",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104245","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057523","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","68303","SERFF","4","2014-01-22 11:51:12","3","68303","IL","Individual","No","39-1263473","68303IL0680003","Humana National Preferred Bronze 4850/6350 Plan","68303IL068",,"ILN001","ILS001","ILF002","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes","http://apps.humana.com/marketing/documents.asp?file=2104245","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2057523","http://apps.humana.com/marketing/documents.asp?file=2067403","68303IL0680003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$25,400","$50,800","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"$9,700","$19,400","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"$4,500","$9,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","4","72547","IL","Individual","No","06-6033492","72547IL0070004","Aetna AdvantagePlus 5500 PD","72547IL007",,"ILN001","ILS001","ILF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070004-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-00","Standard Silver Off Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-01","Standard Silver On Exchange Plan","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-03","Limited Cost Sharing Plan Variation","68.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-04","73% AV Level Silver Plan","73.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","5","72547","IL","Individual","No","06-6033492","72547IL0070008","Aetna Classic 3500 PD","72547IL007",,"ILN001","ILS001","ILF008","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070008-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-01","Standard Silver On Exchange Plan","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$12,700","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-03","Limited Cost Sharing Plan Variation","68.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-04","73% AV Level Silver Plan","72.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,000","$8,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","6","72547","IL","Individual","No","06-6033492","72547IL0070009","Aetna Classic 5000","72547IL007",,"ILN001","ILS001","ILF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070009-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,175","$2,350",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","8","72547","IL","Individual","No","06-6033492","72547IL0070007","Aetna Premier 2000 PD","72547IL007",,"ILN001","ILS001","ILF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070007-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","8","72547","IL","Individual","No","06-6033492","72547IL0070007","Aetna Premier 2000 PD","72547IL007",,"ILN001","ILS001","ILF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","8","72547","IL","Individual","No","06-6033492","72547IL0070007","Aetna Premier 2000 PD","72547IL007",,"ILN001","ILS001","ILF007","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070007-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","72547","SERFF","6","2013-09-19 10:34:04","9","72547","IL","Individual","No","06-6033492","72547IL0070005","Aetna Basic","72547IL007",,"ILN001","ILS001","ILF005","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.992776045514393",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/il.html","72547IL0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-03","Limited Cost Sharing Plan Variation","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-04","73% AV Level Silver Plan","73.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-05","87% AV Level Silver Plan","86.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","75159","SERFF","1","2013-08-01 21:15:43","1","75159","IL","SHOP (Small Group)","Yes","47-0098400","75159IL0030001","EHB Low Passive","75159IL003",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.76",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"75159IL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080001","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0080001-00","Standard Gold Off Exchange Plan","78.24%","0.851065039634705","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010001","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010001-00","Standard Gold Off Exchange Plan","78.24%","0.782447755336761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0090001","Land of Lincoln National Confidence PPO Plan","79763IL009",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Confidence-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0090001-00","Standard Gold Off Exchange Plan","78.16%","0.780481815338135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0090001","Land of Lincoln National Confidence PPO Plan","79763IL009",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Confidence-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0090001-01","Standard Gold On Exchange Plan","78.16%","0.780481815338135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080001","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0080001-01","Standard Gold On Exchange Plan","78.24%","0.851065039634705","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010001","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010001-01","Standard Gold On Exchange Plan","78.24%","0.782447755336761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010001","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0080002","Land of Lincoln National Preferred PPO Plan","79763IL008",,"ILN001","ILS001","ILF005","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"0","0","0","2014-01-01",,"Yes","Benefit Paid as out of network","Yes","50% coinsurance after $4500 Deductible; MOOP is $18750","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Preferred-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0080002-00","Standard Silver Off Exchange Plan","68.35%","0.75461882352829","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","1","79763","IL","Individual","No","90-0962741","79763IL0010001","Land of Lincoln National Preferred PPO Plan","79763IL001",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance after $4050 Deductible; MOOP is $7500","Yes","http://agents.norvax.com/quote/brochure/LLH/preferredGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0010001-03","Limited Cost Sharing Plan Variation","78.24%","0.782447755336761","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$7,500","$15,000","$10,000","$20,000",,,,,,,,,,,,,,,,,,,,,"$1,350","$2,700","20%",,,,"$4,050","$8,100","$5,400","$10,800",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0100002","Land of Lincoln National Complete PPO Plan","79763IL010",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Complete-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0100002-00","Standard Silver Off Exchange Plan","70.38%","0.701461791992188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020001","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF002","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020001-03","Limited Cost Sharing Plan Variation","78.16%","0.780481815338135","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-05","87% AV Level Silver Plan","87.70%","0.875771284103394","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,300","$2,600","$1,300","$2,600","$3,900","$7,800","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%","$500","$1,000","20%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-06","94% AV Level Silver Plan","94.60%","0.945474863052368","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","$1,500","$3,000","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%","$100","$200","10%","$300","$600","$400","$800",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","8","79763","IL","Individual","No","90-0962741","79763IL0060003","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060003-00","Standard Bronze Off Exchange Plan","61.70%","0.618174970149994","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,000","$12,000","40%","$13,500","$27,000","$24,000","$48,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","8","79763","IL","Individual","No","90-0962741","79763IL0060003","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060003-01","Standard Bronze On Exchange Plan","61.70%","0.618174970149994","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,000","$12,000","40%","$13,500","$27,000","$24,000","$48,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","8","79763","IL","Individual","No","90-0962741","79763IL0060003","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","8","79763","IL","Individual","No","90-0962741","79763IL0060003","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060003-03","Limited Cost Sharing Plan Variation","61.70%","0.618174970149994","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$18,000","$36,000","$24,000","$48,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,000","$12,000","40%","$13,500","$27,000","$24,000","$48,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","9","79763","IL","Individual","No","90-0962741","79763IL0070003","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070003-00","Standard Bronze Off Exchange Plan","61.11%","0.612239003181458","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,250","$12,500","40%","$13,500","$27,000","$24,250","$48,500",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","10","79763","IL","Individual","No","90-0962741","79763IL0040003","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $15000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040003-03","Limited Cost Sharing Plan Variation","60.55%","0.619704067707062","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"7"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","1","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0170001","EHB Basic Dental Plan (Low)","83350IL017",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$12.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48039",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48038",,"83350IL0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-01","Standard Silver On Exchange Plan","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0190004","Bronze Deductible Only PPO HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72822","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0190004","Bronze Deductible Only PPO HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72822","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0190004","Bronze Deductible Only PPO HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72822","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0190004","Bronze Deductible Only PPO HSA Eligible Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72822","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0100002","Land of Lincoln National Complete PPO Plan","79763IL010",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"0","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Complete-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0100002-01","Standard Silver On Exchange Plan","70.38%","0.701461791992188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130002","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0130002-01","Standard Silver On Exchange Plan","69.08%","0.683248817920685","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%","$2,000","$4,000","40%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-00","Standard Silver Off Exchange Plan","68.22%","0.678090393543243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","$21,250","$42,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-01","Standard Silver On Exchange Plan","68.22%","0.678090393543243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","$21,250","$42,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-03","Limited Cost Sharing Plan Variation","68.22%","0.678090393543243","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$15,000","$30,000","$21,250","$42,500",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-04","73% AV Level Silver Plan","73.80%","0.736916482448578","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","30%",,,,"$4,800","$9,600","$6,400","$12,800",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-05","87% AV Level Silver Plan","87.70%","0.878571510314941","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$750","$1,500","$1,000","$2,000",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","2","79763","IL","Individual","No","90-0962741","79763IL0020002","Land of Lincoln National Confidence PPO Plan","79763IL002",,"ILN001","ILS001","ILF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/confidenceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0020002-06","94% AV Level Silver Plan","94.20%","0.941445767879486","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$1,800","$3,600","$2,400","$4,800",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$300","$600","$400","$800",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140001","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0140001-00","Standard Gold Off Exchange Plan","78.13%","0.776721179485321","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%","$500","$1,000","25%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0110001","Land of Lincoln National Premier PPO Plan","79763IL011",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Premier-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0110001-00","Standard Gold Off Exchange Plan","78.14%","0.77978527545929","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030001","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030001-00","Standard Gold Off Exchange Plan","79.08%","0.789864182472229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140001","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0140001-01","Standard Gold On Exchange Plan","78.13%","0.776721179485321","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%","$500","$1,000","25%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0110001","Land of Lincoln National Premier PPO Plan","79763IL011",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Premier-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0110001-01","Standard Gold On Exchange Plan","78.14%","0.77978527545929","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030001","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030001-01","Standard Gold On Exchange Plan","79.08%","0.789864182472229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030001","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF003","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $13500.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0110002","Land of Lincoln National Premier PPO Plan","79763IL011",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Premier-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0110002-00","Standard Silver Off Exchange Plan","69.36%","0.69596004486084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140002","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF011","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0140002-00","Standard Silver Off Exchange Plan","69.41%","0.686968863010406","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%","$1,750","$3,500","40%","$5,250","$10,500","$7,000","$14,000",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0110002","Land of Lincoln National Premier PPO Plan","79763IL011",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits Paid according to plan","Yes","50% coinsurance, $6000 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Premier-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0110002-01","Standard Silver On Exchange Plan","69.36%","0.69596004486084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130003","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $6000 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0130003-00","Standard Bronze Off Exchange Plan","61.55%","0.615916907787323","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%","$2,000","$4,000","70%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0130003","Land of Lincoln National Choice PPO Plan","79763IL013",,"ILN001","ILS002","ILF013","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $6000 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Choice-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0130003-01","Standard Bronze On Exchange Plan","61.55%","0.615916907787323","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%","$2,000","$4,000","70%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040001","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040001-01","Standard Gold On Exchange Plan","78.14%","0.77978527545929","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040001","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040001","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040001-03","Limited Cost Sharing Plan Variation","78.14%","0.77978527545929","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-00","Standard Silver Off Exchange Plan","68.23%","0.688468515872955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-01","Standard Silver On Exchange Plan","68.23%","0.688468515872955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-03","Limited Cost Sharing Plan Variation","68.23%","0.688468515872955","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","$16,000","$32,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-04","73% AV Level Silver Plan","73.10%","0.731406152248383","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"$3,750","$7,500","$5,000","$10,000",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040002","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040002-05","87% AV Level Silver Plan","87.40%","0.874675750732422","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$750","$1,500","$1,000","$2,000",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030003","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $18750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","3","79763","IL","Individual","No","90-0962741","79763IL0030003","Land of Lincoln National Complete PPO Plan","79763IL003",,"ILN001","ILS001","ILF009","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $18750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/completeBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0030003-03","Limited Cost Sharing Plan Variation","61.88%","0.666066527366638","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","40%",,,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,"18"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","4","79763","IL","Individual","No","90-0962741","79763IL0040001","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040001-00","Standard Gold Off Exchange Plan","78.14%","0.77978527545929","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%",,,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050001","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050001-00","Standard Gold Off Exchange Plan","78.29%","0.780352294445038","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,750","$19,500","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%",,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140003","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF014","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0140003-00","Standard Bronze Off Exchange Plan","61.91%","0.619653701782227","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","60%","$1,750","$3,500","75%","$5,250","$10,500","$7,000","$14,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050001","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050001-01","Standard Gold On Exchange Plan","78.29%","0.780352294445038","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,750","$19,500","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%",,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0140003","Land of Lincoln National Freedom PPO Plan","79763IL014",,"ILN001","ILS002","ILF014","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999978",,,"0","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18000.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Freedom-Bronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0140003-01","Standard Bronze On Exchange Plan","61.91%","0.619653701782227","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","60%","$1,750","$3,500","75%","$5,250","$10,500","$7,000","$14,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050001","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050001","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050001-03","Limited Cost Sharing Plan Variation","78.29%","0.780352294445038","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,750","$19,500","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%",,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-00","Standard Silver Off Exchange Plan","68.29%","0.686000764369965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$11,250","$22,500","$15,000","$30,000",,,,,,,,,"8"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-01","Standard Silver On Exchange Plan","68.29%","0.686000764369965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$11,250","$22,500","$15,000","$30,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","3","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN003","ILS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$12.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083",,"83350IL0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","4","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN004","ILS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$18.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085",,"83350IL0200001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","4","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0200001","Family Enhanced Dental Plan (High)","83350IL020",,"ILN004","ILS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$18.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes",,,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49085",,"83350IL0200001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0170004","Bronze Deductible Only PPO HSA Eligible Plan","96601IL017",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72806","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0170004","Bronze Deductible Only PPO HSA Eligible Plan","96601IL017",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72806","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-03","Limited Cost Sharing Plan Variation","68.29%","0.686000764369965","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$11,250","$22,500","$15,000","$30,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-04","73% AV Level Silver Plan","72.80%","0.725124835968018","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","$6,000","$12,000",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-05","87% AV Level Silver Plan","87.50%","0.877794086933136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$6,000","$12,000","$8,000","$16,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","5","79763","IL","Individual","No","90-0962741","79763IL0050002","Land of Lincoln National Elite PPO Plan","79763IL005",,"ILN001","ILS001","ILF007","New","PPO","Silver","Yes","Both","No","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $11250 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/eliteSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0050002-06","94% AV Level Silver Plan","93.80%","0.937458992004395","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$2,250","$4,500","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0120001","Land of Lincoln National Elite PPO Plan","79763IL012",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Elite-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0120001-00","Standard Gold Off Exchange Plan","78.29%","0.767171204090118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,750","$19,500","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%",,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"27"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060001","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060001-00","Standard Gold Off Exchange Plan","78.47%","0.778931796550751","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%","$750","$1,500","25%","$2,250","$4,500","$3,000","$6,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060001","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060001-01","Standard Gold On Exchange Plan","78.47%","0.778931796550751","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%","$750","$1,500","25%","$2,250","$4,500","$3,000","$6,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0120001","Land of Lincoln National Elite PPO Plan","79763IL012",,"ILN001","ILS001","ILF004","New","PPO","Gold","Yes","Both","Yes","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $1500 deductible; MOOP $9750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Elite-Gold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0120001-01","Standard Gold On Exchange Plan","78.29%","0.767171204090118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,750","$19,500","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%",,,,"$1,500","$3,000","$2,000","$4,000",,,,,,,,,"5"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","2","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0050001","Managed DentalGuard IL30 Family Plan","87304IL005",,"ILN001","ILS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0170001","Gold $10 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72800","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170001-00","Standard Gold Off Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0170001","Gold $10 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72800","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0170001","Gold $10 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72800","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0170001","Gold $10 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72800","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170001-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0190001","Gold $5 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72816","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0190001","Gold $5 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72816","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0190001","Gold $5 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72816","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0190001","Gold $5 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72816","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0200001","Gold $5 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72824","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0120002","Land of Lincoln National Elite PPO Plan","79763IL012",,"ILN001","ILS001","ILF011","New","PPO","Silver","Yes","Both","Yes","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Elite-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0120002-00","Standard Silver Off Exchange Plan","69.80%","0.647469937801361","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060001","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060001","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $2250 deductible; MOOP $9000.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060001-03","Limited Cost Sharing Plan Variation","78.47%","0.778931796550751","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","25%","$750","$1,500","25%","$2,250","$4,500","$3,000","$6,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","SHOP (Small Group)","No","90-0962741","79763IL0120002","Land of Lincoln National Elite PPO Plan","79763IL012",,"ILN001","ILS001","ILF011","New","PPO","Silver","Yes","Both","Yes","Yes","All, excluding Family and General Practioners; Internists, OB//GYN, Pediatricians and Dentists",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999988",,,"3","0","0","2014-01-01",,"Yes","Benefits paid per plan description","Yes","50% coinsurance, $5250 deductible; MOOP $18750.","Yes","https://www.landoflincolnhealth.org/wp-content/uploads/2013/09/Small-Group-Elite-Silver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/small-business/","79763IL0120002-01","Standard Silver On Exchange Plan","69.80%","0.647469937801361","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$5,250","$10,500","$7,000","$14,000",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-00","Standard Silver Off Exchange Plan","68.20%","0.672502934932709","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$4,000","$8,000","30%","$12,000","$24,000","$16,000","$32,000",,,,,,,,,"8"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0150001","Guardian Family Advantage Plus","85099IL015",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0150001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","4","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0170001","Guardian Family Essentials Plus","85099IL017",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0170001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","4","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0170001","Guardian Family Essentials Plus","85099IL017",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0170001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-01","Standard Silver On Exchange Plan","68.20%","0.672502934932709","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$4,000","$8,000","30%","$12,000","$24,000","$16,000","$32,000",,,,,,,,,"9"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-03","Limited Cost Sharing Plan Variation","68.20%","0.672502934932709","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%","$4,000","$8,000","30%","$12,000","$24,000","$16,000","$32,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-04","73% AV Level Silver Plan","73.40%","0.7258340716362","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$15,000","$30,000","$20,000","$40,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%","$1,250","$2,500","30%","$3,750","$7,500","$5,000","$10,000",,,,,,,,,"12"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-05","87% AV Level Silver Plan","87.80%","0.877649307250977","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$4,500","$9,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%","$250","$500","20%","$750","$1,500","$1,000","$2,000",,,,,,,,,"13"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","6","79763","IL","Individual","No","90-0962741","79763IL0060002","Land of Lincoln National Choice PPO Plan","79763IL006",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/choiceSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0060002-06","94% AV Level Silver Plan","94.40%","0.943319499492645","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$1,800","$3,600","$2,400","$4,800",,,,,,,,,,,,,,,,,,,,,"$50","$100","10%","$50","$100","10%","$150","$300","$200","$400",,,,,,,,,"14"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070001","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070001-00","Standard Gold Off Exchange Plan","78.13%","0.776721179485321","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%","$500","$1,000","25%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070001","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF004","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $1500 deductible; MOOP $10500.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomGold.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070001-01","Standard Gold On Exchange Plan","78.13%","0.776721179485321","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,500","$21,000","$14,000","$28,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","25%","$500","$1,000","25%","$1,500","$3,000","$2,000","$4,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","9","79763","IL","Individual","No","90-0962741","79763IL0070003","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070003-01","Standard Bronze On Exchange Plan","61.11%","0.612239003181458","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,250","$12,500","40%","$13,500","$27,000","$24,250","$48,500",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","9","79763","IL","Individual","No","90-0962741","79763IL0070003","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","9","79763","IL","Individual","No","90-0962741","79763IL0070003","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF008","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $13500 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070003-03","Limited Cost Sharing Plan Variation","61.11%","0.612239003181458","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%","$6,250","$12,500","40%","$13,500","$27,000","$24,250","$48,500",,,,,,,,,"7"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","10","79763","IL","Individual","No","90-0962741","79763IL0040003","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $15000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040003-00","Standard Bronze Off Exchange Plan","60.55%","0.619704067707062","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"4"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","10","79763","IL","Individual","No","90-0962741","79763IL0040003","Land of Lincoln National Premier PPO Plan","79763IL004",,"ILN001","ILS001","ILF010","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $15000 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/premierBronze.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0040003-01","Standard Bronze On Exchange Plan","60.55%","0.619704067707062","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$15,000","$30,000","$20,000","$40,000",,,,,,,,,"5"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-03","Limited Cost Sharing Plan Variation","68.00%","0.671419560909271","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$18,750","$37,500","$25,000","$50,000",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","30%","$4,250","$8,500","30%","$12,750","$25,500","$17,000","$34,000",,,,,,,,,"11"
"2014","IL","79763","SERFF","7","2014-01-22 11:51:12","7","79763","IL","Individual","No","90-0962741","79763IL0070002","Land of Lincoln National Freedom PPO Plan","79763IL007",,"ILN001","ILS002","ILF007","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.999999999999912",,,"3","0","0","2014-01-01",,"Yes","Benefits paid as out of network.","Yes","50% coinsurance, $12750 deductible; MOOP $18750.","Yes","http://agents.norvax.com/quote/brochure/LLH/freedomSilver.pdf","https://paynow.e-zbenefits.com/FFMPaymentBridge/SAML/Payment",,"https://www.landoflincolnhealth.org/shop-for-plans/individuals-and-families/","79763IL0070002-04","73% AV Level Silver Plan","73.60%","0.727719068527222","Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$13,500","$27,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","30%","$4,500","$9,000","$6,000","$12,000",,,,,,,,,"12"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-00","Standard Silver Off Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0190002","Silver $10 PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72817","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-00","Standard Silver Off Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","1","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0170001","EHB Basic Dental Plan (Low)","83350IL017",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$12.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48039",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48038",,"83350IL0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"34"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0170003","Bronze $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72805","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170003-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0170003","Bronze $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72805","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170003-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","2","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0180001","EHB Enhanced Dental Plan (High)","83350IL018",,"ILN002","ILS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$18.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49082",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49081",,"83350IL0180001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","2","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0180001","EHB Enhanced Dental Plan (High)","83350IL018",,"ILN002","ILS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$18.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49082",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49081",,"83350IL0180001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","83350","SERFF","6","2013-10-17 08:32:07","3","83350","IL","SHOP (Small Group)","Yes","13-5581829","83350IL0190001","Family Basic Dental Plan (Low)","83350IL019",,"ILN003","ILS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$12.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49084",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49083",,"83350IL0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0170003","Bronze $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72805","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0170003","Bronze $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72805","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170003-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Bronze $10 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72821","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Bronze $10 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72821","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","84033","SERFF","5","2014-01-22 11:51:12","1","84033","IL","SHOP (Small Group)","Yes","95-6042390","84033IL0010001","BEST Dental PPO M15-S","84033IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IL/pdf/IL_BEST_Dental_PPO_M_15.pdf",,"84033IL0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","84033","SERFF","5","2014-01-22 11:51:12","1","84033","IL","SHOP (Small Group)","Yes","95-6042390","84033IL0010001","BEST Dental PPO M15-S","84033IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.34",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/IL/pdf/IL_BEST_Dental_PPO_M_15.pdf",,"84033IL0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0190001","Guardian Pediatric Advantage","85099IL019",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0190001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0190001","Guardian Pediatric Advantage","85099IL019",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0190001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0200001","Guardian Pediatric Essentials","85099IL020",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0200001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","1","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0200001","Guardian Pediatric Essentials","85099IL020",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0200001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0160001","Guardian Family Advantage","85099IL016",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0160001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0160001","Guardian Family Advantage","85099IL016",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0160001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0180001","Guardian Family Essentials","85099IL018",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0180001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","2","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0180001","Guardian Family Essentials","85099IL018",,"ILN001","ILS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0180001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","85099","SERFF","2","2013-08-05 08:16:03","3","85099","IL","SHOP (Small Group)","Yes","13-5123390","85099IL0150001","Guardian Family Advantage Plus","85099IL015",,"ILN001","ILS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area","Yes",,,,,"85099IL0150001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","86600","SERFF","1","2013-08-01 21:15:43","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010001","DentalConnect�","86600IL001",,"ILN001","ILS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.03",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86600IL0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","86600","SERFF","1","2013-08-01 21:15:43","1","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010002","DentalConnect�","86600IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.31",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86600IL0010002-00","Standard Low Off Exchange Plan","71.66%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","86600","SERFF","1","2013-08-01 21:15:43","2","86600","IL","SHOP (Small Group)","Yes","35-0472300","86600IL0010003","DentalConnect�","86600IL001",,"ILN001","ILS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.24",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"86600IL0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0020001","Managed DentalGuard IL Child Essentials 1","87304IL002",,"ILN001","ILS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0020001","Managed DentalGuard IL Child Essentials 1","87304IL002",,"ILN001","ILS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0010001","Managed DentalGuard IL Child Essentials 2","87304IL001",,"ILN001","ILS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0010001-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","1","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0010001","Managed DentalGuard IL Child Essentials 2","87304IL001",,"ILN001","ILS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.26",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0010001-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","2","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0030001","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","2","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0030001","Managed DentalGuard IL10 Family Plan","87304IL003",,"ILN001","ILS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","IL","87304","SERFF","3","2013-08-09 17:41:07","2","87304","IL","SHOP (Small Group)","Yes","36-4189451","87304IL0040001","Managed DentalGuard IL20 Family Plan","87304IL004",,"ILN001","ILS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"87304IL0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0200001","Gold $5 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72824","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0200001","Gold $5 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72824","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0200001","Gold $5 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72824","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0210001","Gold $5 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72833","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0210001","Gold $5 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72833","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0210001","Gold $5 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72833","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0210001","Gold $5 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF001","New","PPO","Gold","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72833","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0230001","Gold $5 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72819","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230001-00","Standard Gold Off Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0230001","Gold $5 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72819","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0230001","Gold $5 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72819","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","1","96601","IL","Individual","No","37-1241037","96601IL0230001","Gold $5 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF001","New","PPO","Gold","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72819","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0170002","Silver $15 Copay PPO Plan","96601IL017",,"ILN001","ILS001","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72801","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170002-00","Standard Silver Off Exchange Plan","69.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0200002","Silver $10 PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72825","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-00","Standard Silver Off Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0210002","Silver $10 PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF002","New","PPO","Silver","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72834","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","2","96601","IL","Individual","No","37-1241037","96601IL0230002","Silver $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF002","New","PPO","Silver","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72809","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230002-00","Standard Silver Off Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Bronze $10 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72821","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0190003","Bronze $10 Copay PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72821","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0200003","Bronze $10 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72829","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0200003","Bronze $10 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72829","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0200003","Bronze $10 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72829","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0200003","Bronze $10 Copay PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72829","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0210003","Bronze $10 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72838","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0210003","Bronze $10 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72838","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0210003","Bronze $10 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72838","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0210003","Bronze $10 Copay PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF005","New","PPO","Bronze","Yes","Both","Yes","Yes","All","See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72838","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0230003","Bronze $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72813","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0230003","Bronze $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72813","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0230003","Bronze $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72813","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","3","96601","IL","Individual","No","37-1241037","96601IL0230003","Bronze $10 Copay PPO Select","96601IL023",,"ILN002","ILS002","ILF005","New","PPO","Bronze","Yes","Both","Yes","No",,"See Certificate of Coverage for full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72813","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0170004","Bronze Deductible Only PPO HSA Eligible Plan","96601IL017",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72806","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0170004","Bronze Deductible Only PPO HSA Eligible Plan","96601IL017",,"ILN001","ILS001","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72806","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0200004","Bronze Deductible Only PPO HSA Eligible Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72830","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0200004","Bronze Deductible Only PPO HSA Eligible Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72830","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0200004","Bronze Deductible Only PPO HSA Eligible Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72830","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0200004","Bronze Deductible Only PPO HSA Eligible Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72830","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0210004","Bronze Deductible Only PPO HSA Eligible Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72839","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0210004","Bronze Deductible Only PPO HSA Eligible Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72839","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0210004","Bronze Deductible Only PPO HSA Eligible Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72839","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0210004","Bronze Deductible Only PPO HSA Eligible Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF006","New","PPO","Bronze","No","Both","Yes","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72839","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0230004","Bronze Deductible Only PPO Select HSA Eligible Plan","96601IL023",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72814","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230004-00","Standard Bronze Off Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0230004","Bronze Deductible Only PPO Select HSA Eligible Plan","96601IL023",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72814","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0230004","Bronze Deductible Only PPO Select HSA Eligible Plan","96601IL023",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72814","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","4","96601","IL","Individual","No","37-1241037","96601IL0230004","Bronze Deductible Only PPO Select HSA Eligible Plan","96601IL023",,"ILN002","ILS002","ILF006","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"no","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72814","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0170005","Catastrophic 100% PPO Plan","96601IL017",,"ILN001","ILS001","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72807","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0170005","Catastrophic 100% PPO Plan","96601IL017",,"ILN001","ILS001","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72807","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppoil","www.c1formularyhix.com","96601IL0170005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0190005","Catastrophic 100% PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72823","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0190005","Catastrophic 100% PPO Carelink SwedishAmerican","96601IL019",,"ILN003","ILS003","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72823","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposwedishamericanil","www.c1formularyhix.com","96601IL0190005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0200005","Catastrophic 100% PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72831","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0200005","Catastrophic 100% PPO Carelink Methodist","96601IL020",,"ILN004","ILS004","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72831","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppounitypointmethodistil","www.c1formularyhix.com","96601IL0200005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0210005","Catastrophic 100% PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72840","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0210005","Catastrophic 100% PPO Carelink St. John's","96601IL021",,"ILN005","ILS005","ILF007","New","PPO","Catastrophic","No","Both","Yes","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72840","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/ppostjohnsil","www.c1formularyhix.com","96601IL0210005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0230005","Catastrophic 100% PPO Select","96601IL023",,"ILN002","ILS002","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72815","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","IL","96601","SERFF","7","2014-01-22 11:51:12","5","96601","IL","Individual","No","37-1241037","96601IL0230005","Catastrophic 100% PPO Select","96601IL023",,"ILN002","ILS002","ILF007","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Both emergent and elective","Yes","Both emergent and elective","No","http://coventryhealthcare.com/il72815","https://ssoprod.healthplan.com/sp/ACS.saml2","http://coventryone.com/pposelectil","www.c1formularyhix.com","96601IL0230005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360001-01","Standard Platinum On Exchange Plan",,"0.882025182247162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","$1,200","$200","$0","$0","$1,200","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370001","BlueCare PremierSHOP","18558KS037",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierSHOP",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierSHOP&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0370001-01","Standard Gold On Exchange Plan",,"0.785494446754456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$20","$1,200","$200","$400","$1,400","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360016","BlueCare PremierPlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360016-01","Standard Gold On Exchange Plan",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360016","BlueCare PremierPlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","1","61430","KS","Individual","No","75-1296086","61430KS0100001","Gold $5 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72317","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","1","61430","KS","Individual","No","75-1296086","61430KS0100001","Gold $5 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72317","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","Individual","Yes","95-6042390","63790KS0020005","BESTOne Dental Plus - Silver","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"63790KS0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010006","BEST Dental Basic - Silver","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Basic_Plan_(Silver).pdf",,"63790KS0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","1","61430","KS","Individual","No","75-1296086","61430KS0100001","Gold $5 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72317","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360001","BlueCare Elite with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=ElitePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360001-03","Limited Cost Sharing Plan Variation",,"0.882025182247162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","$1,200","$200","$0","$0","$1,200","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360002","BlueCare Deluxe with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360002-01","Standard Gold On Exchange Plan",,"0.780146181583405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","$3,300","$200","$0","$0","$2,700","$40","7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360019-01","Standard Gold On Exchange Plan",,"0.785494446754456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$20","$1,200","$200","$400","$1,400","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360008","BlueCare Deluxe","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360008","BlueCare Deluxe","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360008-03","Limited Cost Sharing Plan Variation",,"0.780146181583405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","$3,300","$200","$0","$0","$2,700","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-04","73% AV Level Silver Plan",,"0.723213791847229","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$1,000","$200","$300","$500","$2,000","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-05","87% AV Level Silver Plan",,"0.864288926124573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$50","$100","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$0","$800","$200","$300","$400","$800","$40","11"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0710008","Anthem Gold Guided Access  - ccab","48396ME071",,"MEN002","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710008-01","Standard Gold On Exchange Plan",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0710008","Anthem Gold Guided Access  - ccab","48396ME071",,"MEN002","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","Individual","No","45-3416923","33653ME0030001","Community Option","33653ME003",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994747795528795",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-VBID-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0030001-00","Standard Bronze Off Exchange Plan","61.96%","0.612226486206055","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$140","$200","$0","$0","$0","$350","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0190001","Community Select","33653ME019",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-BRONZE-VBID.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0190001-01","Standard Bronze On Exchange Plan","61.96%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","80%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,000","$140","$2,720","$0","$0","$0","$560","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","Individual","No","45-3416923","33653ME0030001","Community Option","33653ME003",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994747795528795",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-VBID-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0030001-01","Standard Bronze On Exchange Plan","61.96%","0.612226486206055","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$140","$200","$0","$0","$0","$350","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","Individual","No","45-3416923","33653ME0030001","Community Option","33653ME003",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994747795528795",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-VBID-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Personal Pediatric?","15560MI074","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0740001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430003","Blue Dental PPO Plus SG 90/50/50/50?","15560MI043","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0430003-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430004","Blue Dental PPO Plus SG 80/70/50/50?","15560MI043","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$23.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0430004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-01","Standard Silver On Exchange Plan",,"0.709274232387543","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","11"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-03","Limited Cost Sharing Plan Variation",,"0.709274232387543","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-04","73% AV Level Silver Plan",,"0.729394257068634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-05","87% AV Level Silver Plan",,"0.86604768037796","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$1,400","$200","$0","$0","$1,400","$40","14"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360003","BlueCare SignaturePlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360003-06","94% AV Level Silver Plan",,"0.93876713514328","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$500","$200","$0","$0","$500","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360019-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","8","61430","KS","Individual","No","75-1296086","61430KS0110004","Bronze Deductible Only HSA Eligible PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72398","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0110004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","8","61430","KS","Individual","No","75-1296086","61430KS0110004","Bronze Deductible Only HSA Eligible PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72398","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0110004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","8","61430","KS","Individual","No","75-1296086","61430KS0110004","Bronze Deductible Only HSA Eligible PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72398","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0110004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","9","61430","KS","Individual","No","75-1296086","61430KS0100005","Catastrophic 100% PPO Exchange","61430KS010",,"KSN001","KSS002","KSF006","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72376","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","10","61430","KS","Individual","No","75-1296086","61430KS0110005","Catastrophic 100% PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF006","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72001","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0110005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0010001","Guardian Pediatric Advantage","61779KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0010001","Guardian Pediatric Advantage","61779KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-03","Limited Cost Sharing Plan Variation",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","9"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","1","65598","KS","Individual","No","48-0840330","65598KS0070001","Gold $5 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","1","65598","KS","Individual","No","48-0840330","65598KS0070001","Gold $5 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","1","65598","KS","Individual","No","48-0840330","65598KS0070001","Gold $5 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72334","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","6","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020008","Delta Dental Premier - Preferred Group Addendum","81711KS002",,"KSN003","KSS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$41.32",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,,,,"81711KS0020008-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360030","BlueCare EssentialPlus","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360030-03","Limited Cost Sharing Plan Variation",,"0.582952618598938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","40%",,,,"$10,800","$21,600","Not Applicable","Not Applicable","$5,400","$0","$700","$200","$5,300","$0","$0","$40","18"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360025","BlueCare Premier","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360025-03","Limited Cost Sharing Plan Variation",,"0.785494446754456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$20","$1,200","$200","$400","$1,400","$0","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-06","94% AV Level Silver Plan",,"0.93876713514328","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$500","$200","$0","$0","$500","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360030","BlueCare EssentialPlus","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360030-01","Standard Bronze On Exchange Plan",,"0.582952618598938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","40%",,,,"$10,800","$21,600","Not Applicable","Not Applicable","$5,400","$0","$700","$200","$5,300","$0","$0","$40","16"
"2014","KS","86246","SERFF","2","2013-08-22 18:09:56","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0040002","EHB High PPO","86246KS004",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.44",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86246KS0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","86246","SERFF","2","2013-08-22 18:09:56","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0040001","EHB Low PPO","86246KS004",,"KSN001","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86246KS0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010003","BEST Dental Advantage - Gold","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Advantage_Plan_(Gold).pdf",,"63790KS0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","Individual","Yes","95-6042390","63790KS0020003","BESTOne Dental Advantage - Gold","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"63790KS0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010003","BEST Dental Advantage - Gold","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Advantage_Plan_(Gold).pdf",,"63790KS0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010004","BEST Dental Plus - Gold","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Plus_Plan_(Gold).pdf",,"63790KS0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0020001","Guardian Pediatric Essentials","61779KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0020001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","1","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0020001","Guardian Pediatric Essentials","61779KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0020001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0030001","Guardian Family Advantage Plus","61779KS003",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","2","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0030001","Guardian Family Advantage Plus","61779KS003",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0030001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370005","BlueCare SaverSHOP Select","18558KS037",,"KSN002","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverSHOPSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverSHOPSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0370005-01","Standard Bronze On Exchange Plan",,"0.606328070163727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,350","$24,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$200","$3,000","$0","$1,200","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360010","BlueCare PremierPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360010","BlueCare PremierPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360010-03","Limited Cost Sharing Plan Variation",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","11"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-03","Limited Cost Sharing Plan Variation",,"0.709274232387543","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-04","73% AV Level Silver Plan",,"0.722022593021393","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,400","$20","$1,000","$200","$400","$1,400","$0","$40","18"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-05","87% AV Level Silver Plan",,"0.863641440868378","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$800","$0","$800","$200","$400","$1,100","$0","$40","19"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-06","94% AV Level Silver Plan",,"0.933529555797577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$300","$0","$300","$200","$300","$200","$10","$40","20"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-01","Standard Silver On Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-03","Limited Cost Sharing Plan Variation","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-04","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100006","Silver Integrated $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF010","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72359","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100006-06","94% AV Level Silver Plan","93.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","3","61430","KS","Individual","No","75-1296086","61430KS0100003","Bronze $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72314","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","3","61430","KS","Individual","No","75-1296086","61430KS0100003","Bronze $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72314","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360002","BlueCare Deluxe with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360002","BlueCare Deluxe with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=DeluxePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360002-03","Limited Cost Sharing Plan Variation",,"0.780146181583405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","$3,300","$200","$0","$0","$2,700","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360028","BlueCare EssentialPlus  with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360028-01","Standard Bronze On Exchange Plan",,"0.582952618598938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","40%",,,,"$10,800","$21,600","Not Applicable","Not Applicable","$5,400","$0","$700","$200","$5,300","$0","$0","$40","19"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360028","BlueCare EssentialPlus  with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","20"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","1","18558","KS","Individual","No","48-0952857","18558KS0360028","BlueCare EssentialPlus  with pediatric dental","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360028-03","Limited Cost Sharing Plan Variation",,"0.582952618598938","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,400","$10,800","40%",,,,"$10,800","$21,600","Not Applicable","Not Applicable","$5,400","$0","$700","$200","$5,300","$0","$0","$40","21"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370002","BlueCare SignatureSHOP","18558KS037",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSHOP",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSHOP&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0370002-01","Standard Silver On Exchange Plan",,"0.681725680828094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$200","$2,000","$500","$700","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360007","BlueCare Elite","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360007-01","Standard Platinum On Exchange Plan",,"0.882025182247162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","$1,200","$200","$0","$0","$1,200","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360007","BlueCare Elite","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370003","BlueCare SignatureSHOP Select","18558KS037",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSHOPSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSHOPSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0370003-01","Standard Silver On Exchange Plan",,"0.681725680828094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$200","$2,000","$500","$700","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360007","BlueCare Elite","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Elite&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360007-03","Limited Cost Sharing Plan Variation",,"0.882025182247162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","$1,200","$200","$0","$0","$1,200","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360008","BlueCare Deluxe","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Deluxe&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360008-01","Standard Gold On Exchange Plan",,"0.780146181583405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","$3,300","$200","$0","$0","$2,700","$40","7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-01","Standard Silver On Exchange Plan",,"0.709274232387543","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-04","73% AV Level Silver Plan",,"0.729394257068634","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$3,600","$200","$0","$0","$2,700","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360009","BlueCare SignaturePlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360009-05","87% AV Level Silver Plan",,"0.86604768037796","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","50%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","$1,400","$200","$0","$0","$1,400","$40","14"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-05","87% AV Level Silver Plan",,"0.864288926124573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$50","$100","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$0","$800","$200","$300","$400","$800","$40","17"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-06","94% AV Level Silver Plan",,"0.931155264377594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$0","$300","$200","$200","$200","$100","$40","18"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","2","18558","KS","Individual","No","48-0952857","18558KS0360030","BlueCare EssentialPlus","18558KS036",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360030-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","17"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-01","Standard Silver On Exchange Plan",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-04","73% AV Level Silver Plan","72.44%","0.727405488491058","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-05","87% AV Level Silver Plan","86.17%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$16,500","$33,000","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$16,500","$33,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","3","61430","KS","Individual","No","75-1296086","61430KS0100003","Bronze $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72314","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,500","$35,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","4","61430","KS","Individual","No","75-1296086","61430KS0100004","BronzeDeductible Only HSA Eligible PPO Exchange","61430KS010",,"KSN001","KSS002","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72341","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","4","61430","KS","Individual","No","75-1296086","61430KS0100004","BronzeDeductible Only HSA Eligible PPO Exchange","61430KS010",,"KSN001","KSS002","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72341","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","4","61430","KS","Individual","No","75-1296086","61430KS0100004","BronzeDeductible Only HSA Eligible PPO Exchange","61430KS010",,"KSN001","KSS002","KSF006","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72341","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$22,000","$44,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","Individual","Yes","95-6042390","63790KS0020006","BESTOne Dental Basic - Silver","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"63790KS0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","Individual","Yes","95-6042390","63790KS0020006","BESTOne Dental Basic - Silver","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"63790KS0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010006","BEST Dental Basic - Silver","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Basic_Plan_(Silver).pdf",,"63790KS0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","Individual","Yes","95-6042390","63790KS0020004","BESTOne Dental Plus - Gold","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"63790KS0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010004","BEST Dental Plus - Gold","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Plus_Plan_(Gold).pdf",,"63790KS0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360031-01","Standard Bronze On Exchange Plan",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360031-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360031","BlueCare Essential with pediatric dental","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360031-03","Limited Cost Sharing Plan Variation",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360033","BlueCare Essential Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360033-01","Standard Bronze On Exchange Plan",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","8"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-03","Limited Cost Sharing Plan Variation","68.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-04","73% AV Level Silver Plan","72.60%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$5,000","$10,000","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%","$0","$0","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-04","73% AV Level Silver Plan","73.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","4","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0060001","Guardian Family Essentials","61779KS006",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0060001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","4","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0060001","Guardian Family Essentials","61779KS006",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0060001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-06","94% AV Level Silver Plan","94.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-01","Standard Silver On Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-03","Limited Cost Sharing Plan Variation","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","7","65598","KS","Individual","No","48-0840330","65598KS0080003","Bronze $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF005","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","7","65598","KS","Individual","No","48-0840330","65598KS0080003","Bronze $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF005","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","7","65598","KS","Individual","No","48-0840330","65598KS0080003","Bronze $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF005","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72344","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","8","65598","KS","Individual","No","48-0840330","65598KS0080004","Bronze Deductible Only HSA Eligible POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72354","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360010","BlueCare PremierPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360010-01","Standard Gold On Exchange Plan",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","SHOP (Small Group)","No","48-0952857","18558KS0370004","BlueCare SaverSHOP","18558KS037",,"KSN001","KSS001","KSF004","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverSHOP",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverSHOP&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0370004-01","Standard Bronze On Exchange Plan",,"0.606328070163727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,350","$24,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$0","$2,100","$200","$3,000","$0","$1,200","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-01","Standard Silver On Exchange Plan",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-03","Limited Cost Sharing Plan Variation",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-04","73% AV Level Silver Plan",,"0.723213791847229","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$1,000","$200","$300","$500","$2,000","$40","11"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-05","87% AV Level Silver Plan",,"0.864288926124573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$50","$100","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$0","$800","$200","$300","$400","$800","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360012","BlueCare Signature with pediatric dental","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignaturePdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360012-06","94% AV Level Silver Plan",,"0.931155264377594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$0","$300","$200","$200","$200","$100","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-01","Standard Silver On Exchange Plan",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","14"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-03","Limited Cost Sharing Plan Variation",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","16"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-04","73% AV Level Silver Plan",,"0.723213791847229","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$1,000","$200","$300","$500","$2,000","$40","17"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-05","87% AV Level Silver Plan",,"0.864288926124573","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$50","$100","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$0","$800","$200","$300","$400","$800","$40","18"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","3","18558","KS","Individual","No","48-0952857","18558KS0360013","BlueCare Signature Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360013-06","94% AV Level Silver Plan",,"0.931155264377594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$0","$300","$200","$200","$200","$100","$40","19"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360016","BlueCare PremierPlus","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360016-03","Limited Cost Sharing Plan Variation",,"0.785770952701569","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$1,200","$200","$300","$500","$1,700","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-01","Standard Silver On Exchange Plan",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-03","Limited Cost Sharing Plan Variation",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360017","BlueCare Signature","18558KS036",,"KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Signature&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360017-06","94% AV Level Silver Plan",,"0.931155264377594","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$25","$50","20%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$0","$300","$200","$200","$200","$100","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-01","Standard Silver On Exchange Plan",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","14"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-03","Limited Cost Sharing Plan Variation",,"0.682029366493225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$900","$200","$300","$500","$2,000","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","4","18558","KS","Individual","No","48-0952857","18558KS0360018","BlueCare Signature Select","18558KS036",,"KSN002","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SignatureSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360018-04","73% AV Level Silver Plan",,"0.723213791847229","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","50%",,,,"$100","$200","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$0","$1,000","$200","$300","$500","$2,000","$40","16"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360019","BlueCare Premier with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=PremierPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360019-03","Limited Cost Sharing Plan Variation",,"0.785494446754456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$20","$1,200","$200","$400","$1,400","$0","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-01","Standard Silver On Exchange Plan",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-03","Limited Cost Sharing Plan Variation",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-04","73% AV Level Silver Plan",,"0.722022593021393","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,400","$20","$1,000","$200","$400","$1,400","$0","$40","11"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-05","87% AV Level Silver Plan",,"0.863641440868378","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$800","$0","$800","$200","$400","$1,100","$0","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360021","BlueCare SaverPlus with pediatric dental","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360021-06","94% AV Level Silver Plan",,"0.933529555797577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$300","$0","$300","$200","$300","$200","$10","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-01","Standard Silver On Exchange Plan",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","16"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","5","18558","KS","Individual","No","48-0952857","18558KS0360023","BlueCare SaverPlus Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360023-03","Limited Cost Sharing Plan Variation",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","17"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360025","BlueCare Premier","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360025-01","Standard Gold On Exchange Plan",,"0.785494446754456","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$20","$1,200","$200","$400","$1,400","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360025","BlueCare Premier","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","5","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Premier&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-04","73% AV Level Silver Plan",,"0.722022593021393","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,400","$20","$1,000","$200","$400","$1,400","$0","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-05","87% AV Level Silver Plan",,"0.863641440868378","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$800","$0","$800","$200","$400","$1,100","$0","$40","11"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360026","BlueCare SaverPlus","18558KS036",,"KSN001","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlus&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360026-06","94% AV Level Silver Plan",,"0.933529555797577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$300","$0","$300","$200","$300","$200","$10","$40","12"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-01","Standard Silver On Exchange Plan",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","13"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","14"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-03","Limited Cost Sharing Plan Variation",,"0.685415267944336","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$3,000","$20","$800","$200","$400","$1,500","$0","$40","15"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-04","73% AV Level Silver Plan",,"0.722022593021393","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,800","$9,600",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,400","$4,800","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,400","$20","$1,000","$200","$400","$1,400","$0","$40","16"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-05","87% AV Level Silver Plan",,"0.863641440868378","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$800","$0","$800","$200","$400","$1,100","$0","$40","17"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","6","18558","KS","Individual","No","48-0952857","18558KS0360027","BlueCare SaverPlus Select","18558KS036",,"KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=SaverPlusSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360027-06","94% AV Level Silver Plan",,"0.933529555797577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$300","$0","$300","$200","$300","$200","$10","$40","18"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360033","BlueCare Essential Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360033-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","7","18558","KS","Individual","No","48-0952857","18558KS0360033","BlueCare Essential Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360033-03","Limited Cost Sharing Plan Variation",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","10"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360035","BlueCare Essential","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360035-01","Standard Bronze On Exchange Plan",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360035","BlueCare Essential","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360035-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360035","BlueCare Essential","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Essential&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360035-03","Limited Cost Sharing Plan Variation",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360036","BlueCare Essential Select","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360036-01","Standard Bronze On Exchange Plan",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","7"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360036","BlueCare Essential Select","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360036-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","8","18558","KS","Individual","No","48-0952857","18558KS0360036","BlueCare Essential Select","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","2","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=EssentialSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360036-03","Limited Cost Sharing Plan Variation",,"0.591709315776825","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$40","$0","$40","9"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","9","18558","KS","Individual","No","48-0952857","18558KS0360037","BlueCare Vital with pediatric dental","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360037-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$30","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","9","18558","KS","Individual","No","48-0952857","18558KS0360039","BlueCare Vital Select with pediatric dental","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalSelectPdtl",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalSelectPdtl&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360039-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$30","$0","$40","6"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","10","18558","KS","Individual","No","48-0952857","18558KS0360041","BlueCare Vital","18558KS036",,"KSN001","KSS001","KSF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Vital",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=Vital&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360041-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$30","$0","$40","4"
"2014","KS","18558","SERFF","4","2013-09-13 12:24:07","10","18558","KS","Individual","No","48-0952857","18558KS0360042","BlueCare Vital Select","18558KS036",,"KSN002","KSS001","KSF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","3","2014-01-01",,"Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","Yes","Services performed by contracting providers will be covered as in-network; services provided by non-contracting providers will be covered as out-of-network.","No","http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalSelect",,"http://www.bcbsks.com/HealthPlans/sbc-index.htm?p=VitalSelect&s=b","http://www.bcbsks.com/CustomerService/PrescriptionDrugs/drug_list.htm","18558KS0360042-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,400","$0","$0","$200","$5,100","$30","$0","$40","5"
"2014","KS","31098","SERFF","1","2013-08-01 21:15:43","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0040002","EHB High PPO","31098KS004",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.84",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"31098KS0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","31098","SERFF","1","2013-08-01 21:15:43","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0040001","EHB Low PPO","31098KS004",,"KSN001","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"31098KS0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","31098","SERFF","1","2013-08-01 21:15:43","1","31098","KS","SHOP (Small Group)","Yes","47-0098400","31098KS0030001","EHB Low Passive","31098KS003",,"KSN001","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"31098KS0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","2","61430","KS","Individual","No","75-1296086","61430KS0100002","Silver $10 Copay PPO Exchange","61430KS010",,"KSN001","KSS002","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72323","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks","www.c1formularyhix.com","61430KS0100002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,500","$33,000","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","86246","SERFF","2","2013-08-22 18:09:56","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0030002","EHB High Passive","86246KS003",,"KSN001","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.28",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86246KS0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","86246","SERFF","2","2013-08-22 18:09:56","1","86246","KS","SHOP (Small Group)","Yes","93-0242990","86246KS0030001","EHB Low Passive","86246KS003",,"KSN001","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.08",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"86246KS0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-03","Limited Cost Sharing Plan Variation","69.24%","0.686967134475708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,950","$7,800",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-05","87% AV Level Silver Plan",,"0.862267374992371","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%","$1,500","$3,000","0%","$4,750","$9,500","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$200","300","$0","$40","11"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-06","94% AV Level Silver Plan",,"0.93478786945343","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%","$600","$1,200","0%","$4,750","$9,500","Not Applicable","Not Applicable","$600","$0","$0","$30","$200","300","$0","$40","12"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","5","61430","KS","Individual","No","75-1296086","61430KS0110001","Gold $0 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72305","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110001-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","$9,400","$18,800","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$3,750","$7,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","5","61430","KS","Individual","No","75-1296086","61430KS0110001","Gold $0 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72305","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","5","61430","KS","Individual","No","75-1296086","61430KS0110001","Gold $0 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF003","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72305","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110001-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","$9,400","$18,800","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,750","$7,500","40%","$3,750","$7,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-01","Standard Silver On Exchange Plan","68.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-03","Limited Cost Sharing Plan Variation","68.30%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-04","73% AV Level Silver Plan","72.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$12,800","$25,600","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110002","Silver $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72311","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$12,800","$25,600","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","0%","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%","$4,000","$8,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","6","61430","KS","Individual","No","75-1296086","61430KS0110006","Silver Integrated $10 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF008","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72365","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110006-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","$11,400","$22,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","7","61430","KS","Individual","No","75-1296086","61430KS0110003","Bronze $15 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","7","61430","KS","Individual","No","75-1296086","61430KS0110003","Bronze $15 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","61430","SERFF","7","2013-10-16 19:58:29","7","61430","KS","Individual","No","75-1296086","61430KS0110003","Bronze $15 Copay PPO KC Exchange","61430KS011",,"KSN001","KSS001","KSF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72302","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppoks3-tier","www.c1formularyhix.com","61430KS0110003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","3","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0050001","Guardian Family Essentials Plus","61779KS005",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0050001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","3","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0050001","Guardian Family Essentials Plus","61779KS005",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0050001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","4","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0040001","Guardian Family Advantage","61779KS004",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0040001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","61779","SERFF","3","2013-09-16 08:58:26","4","61779","KS","SHOP (Small Group)","Yes","13-5123390","61779KS0040001","Guardian Family Advantage","61779KS004",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.88",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"61779KS0040001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-04","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0280001","Community Advantage","33653ME028",,"MEN001","MES001","MEF007","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-GOLD.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0280001-00","Standard Gold Off Exchange Plan","81.95%","0.81951105594635","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$650","$1,300","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$650","$100","$910","$0","$0","$88","$0","$0","6"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-03","Limited Cost Sharing Plan Variation","71.74%","0.713219702243805","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$140","$0","$0","7"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0280001","Community Advantage","33653ME028",,"MEN001","MES001","MEF007","New","PPO","Gold","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-GOLD.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0280001-01","Standard Gold On Exchange Plan","81.95%","0.81951105594635","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$650","$1,300","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$650","$100","$910","$0","$0","$88","$0","$0","7"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010001","BEST Life Child Dental Plus","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Child_Dental_Plus_Plan.pdf",,"63790KS0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","1","63790","KS","Individual","Yes","95-6042390","63790KS0020001","BESTOne Child Dental Plus","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Child_Dental_Plus_Plan.pdf",,"63790KS0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","1","63790","KS","Individual","Yes","95-6042390","63790KS0020001","BESTOne Child Dental Plus","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Child_Dental_Plus_Plan.pdf",,"63790KS0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","1","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010001","BEST Life Child Dental Plus","63790KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.79",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Child_Dental_Plus_Plan.pdf",,"63790KS0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010002","BEST Life Child Dental","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Child_Dental_Plan.pdf",,"63790KS0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","2","63790","KS","Individual","Yes","95-6042390","63790KS0020002","BESTOne Child Dental","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Child_Dental_Plan.pdf",,"63790KS0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","2","63790","KS","Individual","Yes","95-6042390","63790KS0020002","BESTOne Child Dental","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Child_Dental_Plan.pdf",,"63790KS0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","2","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010002","BEST Life Child Dental","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Child_Dental_Plan.pdf",,"63790KS0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","Individual","Yes","95-6042390","63790KS0020003","BESTOne Dental Advantage - Gold","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"63790KS0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","3","63790","KS","Individual","Yes","95-6042390","63790KS0020004","BESTOne Dental Plus - Gold","63790KS002",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"63790KS0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010005","BEST Dental Plus - Silver","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Plus_Plan_(Silver).pdf",,"63790KS0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","Individual","Yes","95-6042390","63790KS0020005","BESTOne Dental Plus - Silver","63790KS002",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"63790KS0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","63790","SERFF","6","2014-03-18 09:48:59","4","63790","KS","SHOP (Small Group)","Yes","95-6042390","63790KS0010005","BEST Dental Plus - Silver","63790KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at UCR Level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/KS/pdf/KS_BEST_Dental_Plus_Plan_(Silver).pdf",,"63790KS0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$65","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220002","Blue & U First PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF002","New","PPO","Silver","Yes","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0220002-01","Standard Silver On Exchange Plan","69.60%","0.695975363254547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$10","$1,400","$30","$200","$40","$0","$40","7"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0020001","Community Option HSA","33653ME002",,"MEN001","MES001","MEF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994957812950531",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-HSA-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0020001-03","Limited Cost Sharing Plan Variation",,"0.586790323257446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$0","$1,250","$0","$3,960","$0","$0","$0","9"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0190001","Community Select","33653ME019",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-BRONZE-VBID.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0190001-00","Standard Bronze Off Exchange Plan","61.96%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","80%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,000","$140","$2,720","$0","$0","$0","$560","$0","4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720001","Anthem Bronze Guided Access w/HSA - cacc","48396ME072",,"MEN001","MES002","MEF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S7Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720001-01","Standard Bronze On Exchange Plan","61.64%","0.621212780475616","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","25%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","ME","47540","SERFF","1","2013-08-01 21:15:43","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0040001","EHB Low PPO","47540ME004",,"MEN001","MES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.96",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"47540ME0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720003","Anthem Bronze Guided Access - cabk","48396ME072",,"MEN001","MES002","MEF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S82","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720003-01","Standard Bronze On Exchange Plan","61.31%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720003","Anthem Bronze Guided Access - cabk","48396ME072",,"MEN001","MES002","MEF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S82","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720003","Anthem Bronze Guided Access - cabk","48396ME072",,"MEN001","MES002","MEF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S82","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720003-03","Limited Cost Sharing Plan Variation","61.31%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-01","Standard Silver On Exchange Plan","70.54%","0.70838850736618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-03","Limited Cost Sharing Plan Variation","70.54%","0.70838850736618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-04","73% AV Level Silver Plan","72.99%","0.729906260967255","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,200","$4,400","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-05","87% AV Level Silver Plan","86.11%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710006","Anthem Silver Guided Access w/HSA - cbdo","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S88","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710006-06","94% AV Level Silver Plan","93.08%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720002","Anthem Bronze Guided Access w/HSA - caav","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S80","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720002-01","Standard Bronze On Exchange Plan","58.33%","0.583331704139709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800","0%",,,,"$11,800","$23,600","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-03","Limited Cost Sharing Plan Variation","68.22%","0.679038047790527","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$80","$1,020","$0","$0","$0","$210","$0","7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","No","31-1705652","48396ME0710005","Anthem Bronze Guided Access w/Child Dental - cdaa","48396ME071",,"MEN004","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0810002","Anthem Dental Pediatric Enhanced","48396ME081",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.69",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/me/f0/s0/t0/pw_e213346.pdf",,,,"48396ME0810002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-04","73% AV Level Silver Plan","73.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$1,000","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070002","Silver $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72330","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070002-06","94% AV Level Silver Plan","94.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-01","Standard Silver On Exchange Plan","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-03","Limited Cost Sharing Plan Variation","68.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-04","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-05","87% AV Level Silver Plan","86.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","2","65598","KS","Individual","No","48-0840330","65598KS0070006","Silver Integrated $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF009","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72373","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070006-06","94% AV Level Silver Plan","93.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","3","65598","KS","Individual","No","48-0840330","65598KS0070003","Bronze $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","3","65598","KS","Individual","No","48-0840330","65598KS0070003","Bronze $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","3","65598","KS","Individual","No","48-0840330","65598KS0070003","Bronze $10 Copay POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72335","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","4","65598","KS","Individual","No","48-0840330","65598KS0070004","Bronze Deductible Only HSA Eligible POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72338","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","4","65598","KS","Individual","No","48-0840330","65598KS0070004","Bronze Deductible Only HSA Eligible POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72338","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","4","65598","KS","Individual","No","48-0840330","65598KS0070004","Bronze Deductible Only HSA Eligible POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72338","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","5","65598","KS","Individual","No","48-0840330","65598KS0080001","Gold $5 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72347","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","5","65598","KS","Individual","No","48-0840330","65598KS0080001","Gold $5 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72347","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","5","65598","KS","Individual","No","48-0840330","65598KS0080001","Gold $5 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72347","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$250","$250",,,,,,,,,,,,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080002","Silver $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF002","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72353","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","6","65598","KS","Individual","No","48-0840330","65598KS0080006","Silver Integrated $10 Copay POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF009","New","POS","Silver","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72368","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080006-06","94% AV Level Silver Plan","93.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","8","65598","KS","Individual","No","48-0840330","65598KS0080004","Bronze Deductible Only HSA Eligible POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72354","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","8","65598","KS","Individual","No","48-0840330","65598KS0080004","Bronze Deductible Only HSA Eligible POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF006","New","POS","Bronze","Yes","On the Exchange","No","Yes","All",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72354","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","9","65598","KS","Individual","No","48-0840330","65598KS0070005","Catastrophic 100% POS Kansas Exchange","65598KS007",,"KSN001","KSS001","KSF006","New","POS","Catastrophic","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72377","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posks","www.c1formularyhix.com","65598KS0070005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","65598","SERFF","6","2014-03-18 09:48:59","10","65598","KS","Individual","No","48-0840330","65598KS0080005","Catastrophic 100% POS Wesley Exchange","65598KS008",,"KSN002","KSS002","KSF006","New","POS","Catastrophic","Yes","On the Exchange","No","Yes","All",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Follows non participating provider benefits.","Yes","Follows non participating provider benefits.","No","http://www.coventryhealthcare.com/ks72375","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/poswesleyks","www.c1formularyhix.com","65598KS0080005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","1","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020001","Delta Dental PPO - Basic POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","Low",,"On the Exchange",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$31.39",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","1","81711","KS","Individual","Yes","48-0793267","81711KS0010001","Delta Dental Individual-Basic POEHB","81711KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$29.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalcoversme.com/plan-options/ks-plans","https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.deltadentalcoversme.com/plan-options/ks-plans",,"81711KS0010001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","1","81711","KS","Individual","Yes","48-0793267","81711KS0010001","Delta Dental Individual-Basic POEHB","81711KS001",,"KSN001","KSS001",,"New","PPO","Low",,"Both",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$29.96",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalcoversme.com/plan-options/ks-plans","https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.deltadentalcoversme.com/plan-options/ks-plans",,"81711KS0010001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","2","81711","KS","Individual","Yes","48-0793267","81711KS0010002","Delta Dental Individual-Preferred POEHB","81711KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$37.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalcoversme.com/plan-options/ks-plans","https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.deltadentalcoversme.com/plan-options/ks-plans",,"81711KS0010002-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","13808","SERFF","1","2013-08-01 21:15:43","2","13808","ME","SHOP (Small Group)","Yes","35-0472300","13808ME0010003","DentalConnect�","13808ME001",,"MEN001","MES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"13808ME0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor","33653ME001",,"MEN001","MES001","MEF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993762135610505",,,"0","3","3","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-CATASTROPHIC-07162013-(1).pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0010001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$3,660","$0","$0","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0180001","Community Select HSA","33653ME018",,"MEN001","MES001","MEF002","New","PPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-BRONZE-HSA.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0180001-00","Standard Bronze Off Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","70%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,000","$0","$3,850","$0","$2,000","$0","$1,317","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0180001","Community Select HSA","33653ME018",,"MEN001","MES001","MEF002","New","PPO","Bronze","Yes","Both","Yes","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-BRONZE-HSA.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0180001-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","70%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,000","$0","$3,850","$0","$2,000","$0","$1,317","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0010001","Community Safe Harbor","33653ME001",,"MEN001","MES001","MEF001","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993762135610505",,,"0","3","3","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-CATASTROPHIC-07162013-(1).pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,000","$38,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$3,660","$0","$0","$0","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0140006","Blue & U First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0140006","Blue & U First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140006-03","Limited Cost Sharing Plan Variation",,"0.610948204994202","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","6"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0020001","Community Option HSA","33653ME002",,"MEN001","MES001","MEF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994957812950531",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-HSA-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0020001-00","Standard Bronze Off Exchange Plan",,"0.586790323257446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$0","$1,250","$0","$3,960","$0","$0","$0","6"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0020001","Community Option HSA","33653ME002",,"MEN001","MES001","MEF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994957812950531",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-HSA-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0020001-01","Standard Bronze On Exchange Plan",,"0.586790323257446","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$0","$1,250","$0","$3,960","$0","$0","$0","7"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","1","33653","ME","Individual","No","45-3416923","33653ME0020001","Community Option HSA","33653ME002",,"MEN001","MES001","MEF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994957812950531",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-HSA-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","2","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020002","Delta Dental PPO -Preferred POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","High",,"On the Exchange",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$38.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020002-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","2","81711","KS","Individual","Yes","48-0793267","81711KS0010002","Delta Dental Individual-Preferred POEHB","81711KS001",,"KSN001","KSS001",,"New","PPO","High",,"Both",,,,"Coverage only available for individuals under age 19.",,,,,"Allows Child-Only",,,,"$37.08",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Allows services in the United States and Canada only.","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalcoversme.com/plan-options/ks-plans","https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.deltadentalcoversme.com/plan-options/ks-plans",,"81711KS0010002-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","3","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020003","Delta Dental PPO - Basic Family +POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020003-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","3","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020003","Delta Dental PPO - Basic Family +POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020003-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","4","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020004","Delta Dental PPO - Preferred Family+POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020004-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","4","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020004","Delta Dental PPO - Preferred Family+POEHB","81711KS002",,"KSN002","KSS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes","http://www.deltadentalks.com/IndividualOptions/SHOP/",,"http://www.deltadentalks.com/IndividualOptions/SHOP/",,"81711KS0020004-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","5","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020005","Delta Dental PPO-Basic POEHB Group Addendum","81711KS002",,"KSN002","KSS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$31.39",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,,,,"81711KS0020005-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","5","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020007","Delta Dental Premier - Basic POEHB Addendum","81711KS002",,"KSN003","KSS001",,"New","POS","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$34.42",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,,,,"81711KS0020007-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","KS","81711","SERFF","8","2013-09-17 21:55:00","6","81711","KS","SHOP (Small Group)","Yes","48-0793267","81711KS0020006","Delta Dental PPO - Preferred Group Addendum","81711KS002",,"KSN002","KSS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$38.85",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Provides Coverage in United States and Canada Only","Yes","Care obtained from any Delta Dental Plan Association member company PPO provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide PPO network presence.","Yes",,,,,"81711KS0020006-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160002","Blue & U Classic PCB Gold","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160002-01","Standard Gold On Exchange Plan",,"0.783181190490723","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","900","$0","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160002","Blue & U Classic PCB Gold","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160002","Blue & U Classic PCB Gold","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160002-03","Limited Cost Sharing Plan Variation",,"0.783181190490723","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","900","$0","$40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-01","Standard Silver On Exchange Plan",,"0.687620997428894","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","900","$0","$40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$40","8"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-03","Limited Cost Sharing Plan Variation",,"0.687620997428894","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","900","$0","$40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-04","73% AV Level Silver Plan",,"0.723574995994568","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","10%","$3,000","$6,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","900","$0","$40","10"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-05","87% AV Level Silver Plan",,"0.867246627807617","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$1,000","$2,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$700","$0","$30","$0","500","$0","$40","11"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","1","94248","KS","Individual","No","43-1257251","94248KS0160004","Blue & U Classic PCB Silver","94248KS016","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authoriza","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Pr","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0160004-06","94% AV Level Silver Plan",,"0.938696026802063","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$12,500","$25,000","Not Applicable","Not Applicable","$250","$500","10%","$250","$500","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$400","$0","$30","$0","500","$0","$40","12"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170002","Blue & U Classic Select Gold","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170002-01","Standard Gold On Exchange Plan",,"0.784921765327454","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","700","$0","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220001","Blue & U First PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF001","New","PPO","Gold","Yes","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0220001-00","Standard Gold Off Exchange Plan","78.94%","0.789385318756104","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$10","$800","$30","$200","$40","$0","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170002","Blue & U Classic Select Gold","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220001","Blue & U First PCB Gold","94248KS022","7023011258","KSN001","KSS001","KSF001","New","PPO","Gold","Yes","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0220001-01","Standard Gold On Exchange Plan","78.94%","0.789385318756104","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,800","$5,600",,,"$5,600","$11,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","15%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$1,500","$10","$800","$30","$200","$40","$0","$40","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170002","Blue & U Classic Select Gold","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170002-03","Limited Cost Sharing Plan Variation",,"0.784921765327454","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","10%","$1,500","$3,000","10%","$2,500","$5,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","700","$0","$40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","SHOP (Small Group)","No","43-1257251","94248KS0220002","Blue & U First PCB Silver","94248KS022","7023011258","KSN001","KSS001","KSF002","New","PPO","Silver","Yes","Both","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx",,"http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0220002-00","Standard Silver Off Exchange Plan","69.60%","0.695975363254547","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$10","$1,400","$30","$200","$40","$0","$40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-01","Standard Silver On Exchange Plan",,"0.684849500656128","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","800","$0","$40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-03","Limited Cost Sharing Plan Variation",,"0.684849500656128","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable","$5,000","$10,000","10%","$5,000","$10,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$1,100","$0","$30","$0","800","$0","$40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-04","73% AV Level Silver Plan",,"0.72273313999176","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$12,500","$25,000","Not Applicable","Not Applicable","$3,000","$6,000","10%","$3,000","$6,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$900","$0","$30","$0","800","$0","$40","10"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-05","87% AV Level Silver Plan",,"0.861019134521484","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$12,500","$25,000","Not Applicable","Not Applicable","$1,000","$2,000","10%","$1,000","$2,000","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$700","$0","$30","$0","500","$0","$40","11"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","2","94248","KS","Individual","No","43-1257251","94248KS0170004","Blue & U Classic Select Silver","94248KS017","7023011258","KSN002","KSS001","KSF004","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"5","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0170004-06","94% AV Level Silver Plan",,"0.935858845710754","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$600","$1,200","$600","$1,200","$12,500","$25,000","Not Applicable","Not Applicable","$250","$500","10%","$250","$500","10%","$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$400","$0","$30","$0","500","$0","$40","12"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150002","Blue & U First Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150002-01","Standard Gold On Exchange Plan",,"0.780943870544434","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,700","$5,400","$2,700","$5,400","$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%","$2,700","$5,400","0%","$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","300","$0","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150002","Blue & U First Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$30","$0","$0","$0","$40","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150002","Blue & U First Select Gold","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150002-03","Limited Cost Sharing Plan Variation",,"0.780943870544434","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,700","$5,400","$2,700","$5,400","$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%","$2,700","$5,400","0%","$2,700","$5,400","Not Applicable","Not Applicable","$2,700","$0","$0","$30","$200","300","$0","$40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-01","Standard Silver On Exchange Plan",,"0.692758202552795","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$4,750","$9,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%","$4,750","$9,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","300","$0","$40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-03","Limited Cost Sharing Plan Variation",,"0.692758202552795","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$4,750","$9,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%","$4,750","$9,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$4,750","$0","$0","$30","$200","300","$0","$40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","3","94248","KS","Individual","No","43-1257251","94248KS0150004","Blue & U First Select Silver","94248KS015","7023011258","KSN002","KSS001","KSF002","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150004-04","73% AV Level Silver Plan",,"0.726763725280762","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,750","$7,500","$3,750","$7,500","$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","0%","$3,750","$7,500","0%","$4,750","$9,500","Not Applicable","Not Applicable","$3,750","$0","$0","$30","$200","300","$0","$40","10"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0140006","Blue & U First PCB Bronze","94248KS014","7023011258","KSN001","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140006-01","Standard Bronze On Exchange Plan",,"0.610948204994202","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0150006","Blue & U First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150006-01","Standard Bronze On Exchange Plan",,"0.610948204994202","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0150006","Blue & U First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$30","$0","$0","$0","$40","8"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","4","94248","KS","Individual","No","43-1257251","94248KS0150006","Blue & U First Select Bronze","94248KS015","7023011258","KSN002","KSS001","KSF005","New","PPO","Bronze","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0150006-03","Limited Cost Sharing Plan Variation",,"0.610948204994202","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,250","$12,500","$6,250","$12,500","$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%","$6,250","$12,500","0%","$6,250","$12,500","Not Applicable","Not Applicable","$6,250","$0","$0","$30","$4,300","$0","$0","$40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-01","Standard Silver On Exchange Plan",,"0.683051764965057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,500","$20","$500","$30","$2,500","400","$40","$40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-03","Limited Cost Sharing Plan Variation",,"0.683051764965057","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,500","$20","$500","$30","$2,500","400","$40","$40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-04","73% AV Level Silver Plan",,"0.722181975841522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,125","$6,250",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$2,000","$20","$500","$30","$2,000","500","$40","$40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-05","87% AV Level Silver Plan",,"0.870086133480072","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$800","$1,600","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$800","$20","$400","$30","$800","300","$70","$40","8"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","5","94248","KS","Individual","No","43-1257251","94248KS0180003","Blue & U Saver PCB Silver","94248KS018","7023011258","KSN001","KSS001","KSF003","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0180003-06","94% AV Level Silver Plan",,"0.940562903881073","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$0","$300","$30","$300","200","90","$40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140002","Blue & U First PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140002-01","Standard Gold On Exchange Plan",,"0.788814067840576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","2700","0","0","30","200","300","0","40","4"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140002","Blue & U First PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","0","0","0","30","0","0","0","40","5"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140002","Blue & U First PCB Gold","94248KS014","7023011258","KSN001","KSS001","KSF001","New","PPO","Gold","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140002-03","Limited Cost Sharing Plan Variation",,"0.788814067840576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,700","$5,400",,,"$5,400","$10,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,700","$5,400","0%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","2700","0","0","30","200","300","0","40","6"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-01","Standard Silver On Exchange Plan",,"0.689968287944794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","4750","0","0","30","200","300","0","40","7"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","0","0","0","30","0","0","0","40","8"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-03","Limited Cost Sharing Plan Variation",,"0.689968287944794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","4750","0","0","30","200","300","0","40","9"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-04","73% AV Level Silver Plan",,"0.732715845108032","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","3750","0","0","30","200","300","0","40","10"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-05","87% AV Level Silver Plan",,"0.863930761814117","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","1500","0","0","30","200","300","0","40","11"
"2014","KS","94248","SERFF","6","2014-01-23 12:49:01","12","94248","KS","Individual","No","43-1257251","94248KS0140004","Blue & U First PCB Silver","94248KS014","7023011258","KSN001","KSS001","KSF016","New","PPO","Silver","No","On the Exchange","No","No",,"For services received if there is no obligation for payment or payment has been fully or partially waived. Subject to Prior Auth when approval was not obtained. Not Medically Necessary. Not specifically covered under the Contract. Experimental/Investigative as determined by Us except as provided. For services You are entitled to at no cost for military service related conditions. For losses due in whole or in part to war or any action of war. For genetic testing, except as provided. For court ordered services, including but not limited to examinations, treatment, and genetic testing. For Mason Shunt, banding, gastroplasty, intestinal bypass, gastric balloons, stomach stapling, jejunal bypass, wiring of the jaw and services of a similar nature. For hairplasty or hair removal, regardless of reason or diagnosis. For health and dental services resulting from Accidental Injuries arising out of motor vehicle accidents to the extent such services are payable under any expense payment provision (by whatever term used, including benefits mandated by law) of any automobile insurance policy. For charges when no direct patient contact is provided including but not limited to Physician team conferences, for missed appointments, for completion of forms or other non-medical charges. Health Care Services which are related to complications arising from treatments or services otherwise excluded. For non-prescription enteral feedings and other nutritional and electrolyte supplements. For any diagnosis or treatment of impotency, including drugs. For growth hormone therapy and testing for growth hormone deficiencies in Covered Persons age 19 or older. For services or supplies received from any provider in a country where any sanction, embargo, etc. would prohibit payment or reimbursement. For sales tax. For services, supplies, equipment or care received in connection with a non-covered service, supply, equipment or care. Services and supplies to the extent they are payable by Medicare.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","4","0","2014-01-01","2014-12-31","Yes","We provide benefits through BlueCard Worldwide for all covered services outside the United States, including physician services, maternity services, and elective surgery.  These services will be covered to the extent they would have been covered if they were received within the United States. The services will be subject to the same Prior Authorization requirements and limits indicated in the Contract.","Yes","If You receive services outside of Our Service Area, You may still receive Benefits as if You received such services in Our Service Area through the BlueCard PPO Program. Through the program, You will received the highest level of benefits when you receive services from any Physician, Hospital, or other health care provider designated as  a Preferred Provider in the BlueCard PPO Program.","Yes","http://sbc.bluekc.com/Pages/default.aspx","https://bluekc.oicusa.com/ste/ffmpayment","http://www.bluekc.com/planinfo","http://www.bluekc.com/druglist","94248KS0140004-06","94% AV Level Silver Plan",,"0.935293614864349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"$9,500","$19,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","0%",,,,"$4,750","$9,500","Not Applicable","Not Applicable","600","0","0","30","200","300","0","40","12"
"2014","ME","13808","SERFF","1","2013-08-01 21:15:43","1","13808","ME","SHOP (Small Group)","Yes","35-0472300","13808ME0010001","DentalConnect�","13808ME001",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"13808ME0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","13808","SERFF","1","2013-08-01 21:15:43","1","13808","ME","SHOP (Small Group)","Yes","35-0472300","13808ME0010002","DentalConnect�","13808ME001",,"MEN001","MES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"13808ME0010002-00","Standard Low Off Exchange Plan","71.66%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710002","Anthem Bronze Guided Access w/HSA - caar","48396ME071",,"MEN002","MES001","MEF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7Q","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710002-03","Limited Cost Sharing Plan Variation","58.16%","0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710001","Anthem Bronze Guided Access w/HSA - cabo","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7N","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710001-01","Standard Bronze On Exchange Plan","61.27%","0.614702045917511","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710001","Anthem Bronze Guided Access w/HSA - cabo","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7N","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710001","Anthem Bronze Guided Access w/HSA - cabo","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7N","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710001-03","Limited Cost Sharing Plan Variation","61.27%","0.614702045917511","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-01","Standard Silver On Exchange Plan","69.24%","0.686967134475708","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,950","$7,800",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720006","Anthem Silver Guided Access w/HSA - cbbk","48396ME072",,"MEN001","MES002","MEF010","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8J","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","2","33653","ME","Individual","No","45-3416923","33653ME0030001","Community Option","33653ME003",,"MEN001","MES001","MEF003","New","PPO","Bronze","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994747795528795",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-BRONZE-VBID-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0030001-03","Limited Cost Sharing Plan Variation","61.96%","0.612226486206055","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$5,000","$140","$200","$0","$0","$0","$350","$0","7"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0200001","Community Choice","33653ME020",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-SILVER-68.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0200001-00","Standard Silver Off Exchange Plan","68.16%","0.681620299816132","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$80","$1,020","$0","$0","$0","$210","$0","4"
"2014","ME","47540","SERFF","1","2013-08-01 21:15:43","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0040002","EHB High PPO","47540ME004",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.60",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"47540ME0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720004","Anthem Bronze Guided Access - caaq","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S84","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720004-03","Limited Cost Sharing Plan Variation","59.77%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720002","Anthem Bronze Guided Access w/HSA - caav","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S80","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720002","Anthem Bronze Guided Access w/HSA - caav","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S80","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720002-03","Limited Cost Sharing Plan Variation","58.33%","0.583331704139709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$17,700","$35,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,900","$11,800","0%",,,,"$11,800","$23,600","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0710008","Anthem Gold Guided Access  - ccab","48396ME071",,"MEN002","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710008-03","Limited Cost Sharing Plan Variation",,"0.781078159809113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-01","Standard Silver On Exchange Plan","70.97%","0.716426849365234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-03","Limited Cost Sharing Plan Variation","70.97%","0.716426849365234","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-00","Standard Silver Off Exchange Plan","68.22%","0.679038047790527","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$80","$1,020","$0","$0","$0","$210","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0200001","Community Choice","33653ME020",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-SILVER-68.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0200001-01","Standard Silver On Exchange Plan","68.16%","0.681620299816132","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$80","$1,020","$0","$0","$0","$210","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-01","Standard Silver On Exchange Plan","68.22%","0.679038047790527","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$80","$1,020","$0","$0","$0","$210","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-04","73% AV Level Silver Plan","73.69%","0.7341228723526","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$80","$0","$0","8"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-05","87% AV Level Silver Plan","87.86%","0.876237809658051","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$65","$1,360","$0","$0","$60","$0","$0","9"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0040001","Community Choice","33653ME004",,"MEN001","MES001","MEF004","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995666406569909",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-68-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0040001-06","94% AV Level Silver Plan","94.21%","0.938726603984833","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$200","$55","$245","$0","$0","$40","$0","$0","10"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-00","Standard Silver Off Exchange Plan","68.02%","0.677724003791809","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,350","$50","$1,485","$0","$0","$0","$210","$0","11"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-01","Standard Silver On Exchange Plan","68.02%","0.677724003791809","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,350","$50","$1,485","$0","$0","$0","$210","$0","12"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-03","Limited Cost Sharing Plan Variation","70.69%","0.712516844272614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-04","73% AV Level Silver Plan","72.99%","0.73380970954895","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,450","$4,900","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0710009","Anthem Gold Guided Access w/Child Dental  - cdcp","48396ME071",,"MEN004","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0710009","Anthem Gold Guided Access w/Child Dental  - cdcp","48396ME071",,"MEN004","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710009-03","Limited Cost Sharing Plan Variation",,"0.781129002571106","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0720009","Anthem Gold Guided Access w/Child Dental - cdcx","48396ME072",,"MEN003","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S90","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720009-01","Standard Gold On Exchange Plan","79.97%","0.804697930812836","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0720009","Anthem Gold Guided Access w/Child Dental - cdcx","48396ME072",,"MEN003","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S90","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0720009","Anthem Gold Guided Access w/Child Dental - cdcx","48396ME072",,"MEN003","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S90","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720009-03","Limited Cost Sharing Plan Variation","79.97%","0.804697930812836","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0740002","Silver Guided Access Plus-gfqa","48396ME074",,"MEN001","MES002","MEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985659205660636",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0740002-01","Standard Silver On Exchange Plan","68.89%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"4"
"2014","ME","47540","SERFF","1","2013-08-01 21:15:43","1","47540","ME","SHOP (Small Group)","Yes","93-0242990","47540ME0030002","EHB High Passive","47540ME003",,"MEN001","MES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$51.04",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"47540ME0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0810001","Anthem Dental Pediatric","48396ME081",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149614.pdf",,,,"48396ME0810001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-03","Limited Cost Sharing Plan Variation","68.02%","0.677724003791809","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","50%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,350","$50","$1,485","$0","$0","$0","$210","$0","14"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","9","48396","ME","Individual","No","31-1705652","48396ME0710010","Anthem Catastrophic Guided Access","48396ME071",,"MEN002","MES001","MEF002","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S92","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","9","48396","ME","Individual","No","31-1705652","48396ME0720010","Anthem Catastrophic Guided Access","48396ME072",,"MEN001","MES002","MEF005","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S94","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross� Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$40","19"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross� Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-03","Limited Cost Sharing Plan Variation","78.00%","0.808510422706604","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","20%",,,,"$300","$600","Not Applicable","Not Applicable","$150","$500","$1,100","$150","$150","$180","$890","$40","20"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-04","73% AV Level Silver Plan","73.88%","0.736443936824799","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$80","$0","$0","15"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-05","87% AV Level Silver Plan","87.86%","0.876284420490265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$65","$1,360","$0","$0","$60","$0","$0","16"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","3","33653","ME","Individual","No","45-3416923","33653ME0140001","Community Value","33653ME014",,"MEN001","MES001","MEF007","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995492026740901",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-VALUE-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0140001-06","94% AV Level Silver Plan","94.21%","0.938743531703949","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$200","$55","$245","$0","$0","$40","$0","$0","17"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-00","Standard Silver Off Exchange Plan","71.74%","0.713219702243805","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$140","$0","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0240001","Community Preferred","33653ME024",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-SILVER-72.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0240001-00","Standard Silver Off Exchange Plan","71.74%","0.717414617538452","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$140","$0","$0","4"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","SHOP (Small Group)","No","45-3416923","33653ME0240001","Community Preferred","33653ME024",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-SG-SILVER-72.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/SmallGroup-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0240001-01","Standard Silver On Exchange Plan","71.74%","0.717414617538452","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$140","$0","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-01","Standard Silver On Exchange Plan","71.74%","0.713219702243805","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$140","$0","$0","5"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-04","73% AV Level Silver Plan","73.92%","0.735434830188751","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,350","$8,700",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$2,000","$115","$960","$0","$0","$80","$0","$0","8"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-05","87% AV Level Silver Plan","87.68%","0.873762786388397","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$65","$1,360","$0","$0","$60","$0","$0","9"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0080001","Community Preferred","33653ME008",,"MEN001","MES001","MEF005","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.995914874437123",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-SILVER-72-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0080001-06","94% AV Level Silver Plan","94.16%","0.93886399269104","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$200","$55","$245","$0","$0","$40","$0","$0","10"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0120001","Community Advantage","33653ME012",,"MEN001","MES001","MEF006","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996579541280098",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-GOLD-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0120001-00","Standard Gold Off Exchange Plan","81.95%","0.816188991069794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$650","$1,300","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$650","$100","$910","$0","$0","$88","$0","$0","11"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370002","Priority Health PPO - 90 Platinum 250","29241MI037",,"MIN001","MIS001","MIF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/601BD82829C74B3B8FF2258A8B186A40.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370002-00","Standard Platinum Off Exchange Plan",,"0.894836068153381","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400","Not Applicable","Not Applicable","$250","$500","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370002","Priority Health PPO - 90 Platinum 250","29241MI037",,"MIN001","MIS001","MIF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/601BD82829C74B3B8FF2258A8B186A40.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370002-01","Standard Platinum On Exchange Plan",,"0.894836068153381","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400","Not Applicable","Not Applicable","$250","$500","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-03","Limited Cost Sharing Plan Variation",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","7"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370003","Priority Health PPO Gold 500 2-tier Rx","29241MI037",,"MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/B83F1E8FF6764A6A9D3BFA1A8CB22927.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370003-00","Standard Gold Off Exchange Plan",,"0.818236649036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-04","73% AV Level Silver Plan",,"0.729930698871613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$1,800","$0","$1,500","$900","$900","$0","8"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370003","Priority Health PPO Gold 500 2-tier Rx","29241MI037",,"MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/B83F1E8FF6764A6A9D3BFA1A8CB22927.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370003-01","Standard Gold On Exchange Plan",,"0.818236649036407","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-05","87% AV Level Silver Plan",,"0.877419531345367","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500","30%",,,,"$500","$1,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$0","$1,000","$0","$250","$900","$100","$0","9"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0200001","Delta Dental PPO Family High Plan","50165ME020",,"MEN001","MES001",,"New","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$39.36",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage.","Yes","Same coverage.","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20145.pdf",,"50165ME0200001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","1","50165","ME","Individual","Yes","01-0286541","50165ME0160001","Delta Dental Family High Plan","50165ME016",,"MEN001","MES001",,"New","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$39.36",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20141.pdf",,"50165ME0160001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440005","Blue Dental PPO SG 80/60/50 (50/50/50)?","15560MI044","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$18.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0440005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-03","Limited Cost Sharing Plan Variation","68.10%","0.699648082256317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$500","$850","$150","$1,400","$90","$725","$40","13"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0120001","Community Advantage","33653ME012",,"MEN001","MES001","MEF006","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996579541280098",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-GOLD-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0120001-01","Standard Gold On Exchange Plan","81.95%","0.816188991069794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$650","$1,300","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$650","$100","$910","$0","$0","$88","$0","$0","12"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0120001","Community Advantage","33653ME012",,"MEN001","MES001","MEF006","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996579541280098",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-GOLD-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0120001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","ME","33653","SERFF","6","2014-01-21 11:24:32","4","33653","ME","Individual","No","45-3416923","33653ME0120001","Community Advantage","33653ME012",,"MEN001","MES001","MEF006","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996579541280098",,,"0","0","0","2014-01-01",,"Yes","Inpatient/Outpatient Hospital servs with Prior Approval.  Seek reimbursement.","Yes","National wrap network provided by FirstHealth","Yes","http://www.maineoptions.org/Documents/MCHO-SBC-Ind-GOLD-07162013.pdf","https://enroll.maineoptions.org/ehp/eapp/samlpaymentacs","http://www.maineoptions.org/Documents/Individual-Plan-Brochure.pdf","http://www.maineoptions.org/Documents/Maine-Comple-formulary","33653ME0120001-03","Limited Cost Sharing Plan Variation","81.95%","0.816188991069794","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$650","$1,300","20%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$650","$100","$910","$0","$0","$88","$0","$0","14"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-04","73% AV Level Silver Plan","72.99%","0.735651254653931","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-05","87% AV Level Silver Plan","86.11%","0.862908780574799","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720007","Anthem Silver Guided Access - cbdk","48396ME072",,"MEN001","MES002","MEF011","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8P","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720007-06","94% AV Level Silver Plan","93.08%","0.932125985622406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720008","Anthem Gold Guided Access - ccaj","48396ME072",,"MEN001","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720008-01","Standard Gold On Exchange Plan","79.97%","0.804724991321564","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720008","Anthem Gold Guided Access - ccaj","48396ME072",,"MEN001","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","7","48396","ME","Individual","No","31-1705652","48396ME0720008","Anthem Gold Guided Access - ccaj","48396ME072",,"MEN001","MES002","MEF013","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S8Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720008-03","Limited Cost Sharing Plan Variation","79.97%","0.804724991321564","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","5%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-01","Standard Silver On Exchange Plan","70.69%","0.712516844272614","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","No","31-1705652","48396ME0710005","Anthem Bronze Guided Access w/Child Dental - cdaa","48396ME071",,"MEN004","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710005-01","Standard Bronze On Exchange Plan","59.87%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730003","Bronze Guided Access Plus-gqbf","48396ME073",,"MEN001","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.982983855630727",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0730003-01","Standard Bronze On Exchange Plan","61.97%","0","No","No","No","100%",,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","$4,500","$9,000","$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","Yes","31-1705652","48396ME0840001","Anthem Dental Pediatric","48396ME084",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149614.pdf",,,,"48396ME0840001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","Yes","31-1705652","48396ME0840001","Anthem Dental Pediatric","48396ME084",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149614.pdf",,,,"48396ME0840001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0810001","Anthem Dental Pediatric","48396ME081",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.11",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149614.pdf",,,,"48396ME0810001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720004","Anthem Bronze Guided Access - caaq","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S84","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720004-01","Standard Bronze On Exchange Plan","59.77%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0720004","Anthem Bronze Guided Access - caaq","48396ME072",,"MEN001","MES002","MEF005","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S84","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720001","Anthem Bronze Guided Access w/HSA - cacc","48396ME072",,"MEN001","MES002","MEF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S7Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0720001","Anthem Bronze Guided Access w/HSA - cacc","48396ME072",,"MEN001","MES002","MEF004","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S7Y","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720001-03","Limited Cost Sharing Plan Variation","61.64%","0.621212780475616","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","25%",,,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710002","Anthem Bronze Guided Access w/HSA - caar","48396ME071",,"MEN002","MES001","MEF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7Q","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710002-01","Standard Bronze On Exchange Plan","58.16%","0.580579996109009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","6","48396","ME","Individual","No","31-1705652","48396ME0710002","Anthem Bronze Guided Access w/HSA - caar","48396ME071",,"MEN002","MES001","MEF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7Q","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross� Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-00","Standard Gold Off Exchange Plan","78.00%","0.808510422706604","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","20%",,,,"$300","$600","Not Applicable","Not Applicable","$150","$500","$1,100","$150","$150","$180","$890","$40","17"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350004","Blue Cross� Premier Gold","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350004-01","Standard Gold On Exchange Plan","78.00%","0.808510422706604","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"$10,200","$20,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","20%",,,,"$300","$600","Not Applicable","Not Applicable","$150","$500","$1,100","$150","$150","$180","$890","$40","18"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270062","MyPriority MyHealth Access Gold 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/FB11BD0767A04A9DB1C835F4275BCD93.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270062-00","Standard Gold Off Exchange Plan",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","11"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370005","Priority Health PPO Gold 1000","29241MI037",,"MIN001","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/8896AD46A76D46009E1527007E28D5EE.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370005-00","Standard Gold Off Exchange Plan",,"0.78711599111557","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370005","Priority Health PPO Gold 1000","29241MI037",,"MIN001","MIS001","MIF002","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/8896AD46A76D46009E1527007E28D5EE.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370005-01","Standard Gold On Exchange Plan",,"0.78711599111557","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$7,600","$15,200","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","No","31-1705652","48396ME0710005","Anthem Bronze Guided Access w/Child Dental - cdaa","48396ME071",,"MEN004","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710005-03","Limited Cost Sharing Plan Variation","59.87%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","Yes","31-1705652","48396ME0840002","Anthem Dental Pediatric Enhanced","48396ME084",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.69",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/me/f0/s0/t0/pw_e213346.pdf",,,,"48396ME0840002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-05","87% AV Level Silver Plan","86.54%","0.8677778840065","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","8","48396","ME","Individual","No","31-1705652","48396ME0710007","Anthem Silver Guided Access - cbbc","48396ME071",,"MEN002","MES001","MEF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8D","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710007-06","94% AV Level Silver Plan","93.40%","0.935820996761322","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$650","$1,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","Individual","Yes","38-2069753","15560MI0740001","Blue Dental PPO Personal Pediatric?","15560MI074","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0740001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430001","Blue Dental PPO Plus SG 100/80/50/50?","15560MI043","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$29.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0430001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430002","Blue Dental PPO Plus SG 100/80/50/50?","15560MI043","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$29.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0430002-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-00","Standard Silver Off Exchange Plan","68.10%","0.699648082256317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$500","$850","$150","$1,400","$90","$725","$40","10"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-01","Standard Silver On Exchange Plan","68.10%","0.699648082256317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$2,800","$5,600","Not Applicable","Not Applicable","$1,400","$500","$850","$150","$1,400","$90","$725","$40","11"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440003","Blue Dental PPO SG 100/80/50 (50/50/50)?","15560MI044","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$21.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0440003-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$40","12"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440004","Blue Dental PPO SG 80/60/50 (50/50/50)?","15560MI044","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$18.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0440004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-04","73% AV Level Silver Plan","72.20%","0.740858197212219","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$1,000","$500","$930","$150","$1,000","$150","$740","$40","14"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0460001","Blue Dental EPO SG 100/80/50?","15560MI046","7538162760","MIN002","MIS002",,"New","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$21.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0460001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","2","20393","MI","Individual","No","38-3252216","20393MI0040004","McLaren Young Adult","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No",,,"1",,,"0","3","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency or otherwise requires out of area waiver from plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","100%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"4"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370001","Priority Health PPO - 100 Platinum 250","29241MI037",,"MIN001","MIS001","MIF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/5C15082BE52E4626A1498CC77253BC63.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370001-00","Standard Platinum Off Exchange Plan",,"0.895786881446838","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-00","Standard Silver Off Exchange Plan",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","4"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370001","Priority Health PPO - 100 Platinum 250","29241MI037",,"MIN001","MIS001","MIF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/5C15082BE52E4626A1498CC77253BC63.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370001-01","Standard Platinum On Exchange Plan",,"0.895786881446838","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-01","Standard Silver On Exchange Plan",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","5"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270061","MyPriority MyHealth Access Silver 2500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/3E108FB8CC4A44F0ABBE90C30D6988EB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270061-06","94% AV Level Silver Plan",,"0.948239982128143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$800","$1,600","Not Applicable","Not Applicable","$100","$200","30%",,,,"$200","$400","Not Applicable","Not Applicable","$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$300","$0","$100","$300","$0","$0","10"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0810002","Anthem Dental Pediatric Enhanced","48396ME081",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.69",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/me/f0/s0/t0/pw_e213346.pdf",,,,"48396ME0810002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","1","48396","ME","Individual","Yes","31-1705652","48396ME0840002","Anthem Dental Pediatric Enhanced","48396ME084",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.69",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/me/f0/s0/t0/pw_e213346.pdf",,,,"48396ME0840002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830001","Anthem Dental Family","48396ME083",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149612.pdf",,,,"48396ME0830001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730002","Silver Guided Access Plus-gfqa","48396ME073",,"MEN001","MES001","MEF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.985659205660636",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0730002-01","Standard Silver On Exchange Plan","68.89%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","$5,500","$11,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","Yes","31-1705652","48396ME0860001","Anthem Dental Family","48396ME086",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149612.pdf",,,,"48396ME0860001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","No","31-1705652","48396ME0720005","Anthem Bronze Guided Access w/Child Dental - cdaq","48396ME072",,"MEN003","MES002","MEF005","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S86","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720005-01","Standard Bronze On Exchange Plan",,"0.597690224647522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","Yes","31-1705652","48396ME0860001","Anthem Dental Family","48396ME086",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149612.pdf",,,,"48396ME0860001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","No","31-1705652","48396ME0720005","Anthem Bronze Guided Access w/Child Dental - cdaq","48396ME072",,"MEN003","MES002","MEF005","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S86","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730001","Gold Guided Access Plus-groa","48396ME073",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98879217569356",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0730001-00","Standard Gold Off Exchange Plan","79.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830001","Anthem Dental Family","48396ME083",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.48",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149612.pdf",,,,"48396ME0830001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","Yes","31-1705652","48396ME0860002","Anthem Dental Family Enhanced","48396ME086",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149613.pdf",,,,"48396ME0860002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0730001","Gold Guided Access Plus-groa","48396ME073",,"MEN001","MES001","MEF001","New","HMO","Gold","Yes","Both","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98879217569356",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0730001-01","Standard Gold On Exchange Plan","79.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","No","31-1705652","48396ME0720005","Anthem Bronze Guided Access w/Child Dental - cdaq","48396ME072",,"MEN003","MES002","MEF005","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","Yes","http://www.sbc.anthem.com/dps/CCD0S86","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0720005-03","Limited Cost Sharing Plan Variation",,"0.597690224647522","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830002","Anthem Dental Family Enhanced","48396ME083",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149613.pdf",,,,"48396ME0830002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","Individual","Yes","31-1705652","48396ME0860002","Anthem Dental Family Enhanced","48396ME086",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149613.pdf",,,,"48396ME0860002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","2","48396","ME","SHOP (Small Group)","Yes","31-1705652","48396ME0830002","Anthem Dental Family Enhanced","48396ME083",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/shared/me/f3/s0/t0/pw_b149613.pdf",,,,"48396ME0830002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0740003","Bronze Guided Access Plus-gqbf","48396ME074",,"MEN001","MES002","MEF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.982983855630727",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0740003-01","Standard Bronze On Exchange Plan","61.97%",,"No","No","No","100%",,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,500","$7,000",,,"$3,500","$7,000","$3,500","$7,000",,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$250","$500","30%",,,,"$250","$500","$250","$500",,,,,,,,,,,,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","3","48396","ME","Individual","No","31-1705652","48396ME0710009","Anthem Gold Guided Access w/Child Dental  - cdcp","48396ME071",,"MEN004","MES001","MEF012","New","HMO","Gold","No","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S8W","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710009-01","Standard Gold On Exchange Plan",,"0.781129002571106","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","Individual","No","31-1705652","48396ME0710004","Anthem Bronze Guided Access - caaa","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710004-01","Standard Bronze On Exchange Plan","59.87%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","Individual","No","31-1705652","48396ME0710004","Anthem Bronze Guided Access - caaa","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0740001","Gold Guided Access Plus-groa","48396ME074",,"MEN001","MES002","MEF002","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98879217569356",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0740001-00","Standard Gold Off Exchange Plan","79.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","Individual","No","31-1705652","48396ME0710004","Anthem Bronze Guided Access - caaa","48396ME071",,"MEN002","MES001","MEF008","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7U","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710004-03","Limited Cost Sharing Plan Variation","59.87%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","4","48396","ME","SHOP (Small Group)","No","31-1705652","48396ME0740001","Gold Guided Access Plus-groa","48396ME074",,"MEN001","MES002","MEF002","New","POS","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98879217569356",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/me","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0740001-01","Standard Gold On Exchange Plan","79.92%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000",,,,,,,,,"6"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0710003","Anthem Bronze Guided Access - cabr","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7S","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710003-01","Standard Bronze On Exchange Plan","61.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0710003","Anthem Bronze Guided Access - cabr","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7S","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","ME","48396","SERFF","11","2014-06-23 15:22:56","5","48396","ME","Individual","No","31-1705652","48396ME0710003","Anthem Bronze Guided Access - cabr","48396ME071",,"MEN002","MES001","MEF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral with the exception of OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Requires pre-approval.","Yes","Requires pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0S7S","https://shop.bcbsga.com/sales/eox/payment/landing/me","http://file.anthem.com/03255MEMENABS.pdf","www.anthem.com/MESelectdrugtier4","48396ME0710003-03","Limited Cost Sharing Plan Variation","61.95%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270062","MyPriority MyHealth Access Gold 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/FB11BD0767A04A9DB1C835F4275BCD93.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270062-01","Standard Gold On Exchange Plan",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","12"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270062","MyPriority MyHealth Access Gold 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/FB11BD0767A04A9DB1C835F4275BCD93.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270062-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270062","MyPriority MyHealth Access Gold 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/FB11BD0767A04A9DB1C835F4275BCD93.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270062-03","Limited Cost Sharing Plan Variation",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","14"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270063","MyPriority MyHealth Access Gold 1000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/635492A099A04428B57395926EA24030.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270063-00","Standard Gold Off Exchange Plan",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","15"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270063","MyPriority MyHealth Access Gold 1000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/635492A099A04428B57395926EA24030.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270063-01","Standard Gold On Exchange Plan",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","16"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","3","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN003","MIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$18.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089",,"11083MI0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","3","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0120001","Family Basic Dental Plan (Low)","11083MI012",,"MIN003","MIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$18.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49090",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49089",,"11083MI0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","4","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN004","MIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091",,"11083MI0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross� Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-00","Standard Bronze Off Exchange Plan","58.70%","0.579830527305603","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,670","$500","$0","$150","$5,260","$0","$0","$40","6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Personal?","15560MI072","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$22.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0720001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross� Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-01","Standard Bronze On Exchange Plan","58.70%","0.579830527305603","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,670","$500","$0","$150","$5,260","$0","$0","$40","7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420004","Blue Dental PPO Plus SG 80/70/50?","15560MI042","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$23.35",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0420004-00","Standard Low Off Exchange Plan","70.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","1","50165","ME","Individual","Yes","01-0286541","50165ME0170001","Delta Dental Family Low Plan","50165ME017",,"MEN001","MES001",,"New","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$31.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20142.pdf",,"50165ME0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"$150","Not Applicable","$150","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","1","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0210001","Delta Dental PPO Family Low Plan","50165ME021",,"MEN001","MES001",,"New","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$31.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage.","Yes","Same coverage.","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20146.pdf",,"50165ME0210001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"$150","Not Applicable","$150","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","2","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0220001","Delta Dental PPO Pediatric High Plan","50165ME022",,"MEN001","MES001",,"New","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$39.36",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same coverage","Yes","Same coverage","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20147.pdf",,"50165ME0220001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","2","50165","ME","Individual","Yes","01-0286541","50165ME0180001","Delta Dental Pediatric High Plan","50165ME018",,"MEN001","MES001",,"New","PPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$39.36",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20143.pdf",,"50165ME0180001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","2","50165","ME","Individual","Yes","01-0286541","50165ME0190001","Delta Dental Pediatric Low Plan","50165ME019",,"MEN001","MES001",,"New","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$31.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same Coverage","Yes","Same Coverage","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20144.pdf",,"50165ME0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"$150","Not Applicable","$150","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","50165","SERFF","3","2013-09-11 14:31:09","2","50165","ME","SHOP (Small Group)","Yes","01-0286541","50165ME0230001","Delta Dental PPO Pediatric Low Plan","50165ME023",,"MEN001","MES001",,"New","PPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$31.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","Yes","Same coverage","Yes","Same coverage","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/me/oocme20148.pdf",,"50165ME0230001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"$150","Not Applicable","$150","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0050001","Guardian Pediatric Advantage","69227ME005",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0050001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0050001","Guardian Pediatric Advantage","69227ME005",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0050001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0060001","Guardian Pediatric Essentials","69227ME006",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0060001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","1","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0060001","Guardian Pediatric Essentials","69227ME006",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0060001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0070001","Guardian Family Advantage Plus","69227ME007",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0070001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","2","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0070001","Guardian Family Advantage Plus","69227ME007",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0070001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","3","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0090001","Guardian Family Essentials Plus","69227ME009",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0090001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","3","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0090001","Guardian Family Essentials Plus","69227ME009",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0090001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","4","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0080001","Guardian Family Advantage","69227ME008",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0080001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","4","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0080001","Guardian Family Advantage","69227ME008",,"MEN001","MES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.75",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0080001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","4","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0100001","Guardian Family Essentials","69227ME010",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0100001-00","Standard Low Off Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","ME","69227","SERFF","4","2013-09-16 08:58:26","4","69227","ME","SHOP (Small Group)","Yes","13-5123390","69227ME0100001","Guardian Family Essentials","69227ME010",,"MEN001","MES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"69227ME0100001-01","Standard Low On Exchange Plan","69.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","1","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0100001","EHB Basic Dental Plan (Low)","11083MI010",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$18.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48043",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48042",,"11083MI0100001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","1","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0100001","EHB Basic Dental Plan (Low)","11083MI010",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$18.40",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48043",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48042",,"11083MI0100001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","2","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0110001","EHB Enhanced Dental Plan (High)","11083MI011",,"MIN002","MIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49088",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49087",,"11083MI0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","2","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0110001","EHB Enhanced Dental Plan (High)","11083MI011",,"MIN002","MIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49088",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49087",,"11083MI0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11083","SERFF","7","2013-10-17 08:32:07","4","11083","MI","SHOP (Small Group)","Yes","13-5581829","11083MI0130001","Family Enhanced Dental Plan (High)","11083MI013",,"MIN004","MIS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$24.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49092",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49091",,"11083MI0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0020001","Managed DentalGuard MI Child Essentials 1","11103MI002",,"MIN001","MIS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0020001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0020001","Managed DentalGuard MI Child Essentials 1","11103MI002",,"MIN001","MIS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0020001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0010001","Managed DentalGuard MI Child Essentials 2","11103MI001",,"MIN001","MIS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0010001-00","Standard High Off Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","1","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0010001","Managed DentalGuard MI Child Essentials 2","11103MI001",,"MIN001","MIS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0010001-01","Standard High On Exchange Plan","85.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","2","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0030001","Managed DentalGuard MI10 Family Plan","11103MI003",,"MIN001","MIS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0030001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","2","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0030001","Managed DentalGuard MI10 Family Plan","11103MI003",,"MIN001","MIS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"11103MI0030001-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","2","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0040001","Managed DentalGuard MI20 Family Plan","11103MI004",,"MIN001","MIS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"11103MI0040001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","11103","SERFF","3","2013-09-11 14:31:09","2","11103","MI","SHOP (Small Group)","Yes","36-4117539","11103MI0050001","Managed DentalGuard MI30 Family Plan","11103MI005",,"MIN001","MIS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$13.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"11103MI0050001-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Personal?","15560MI071","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$27.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0710001-00","Standard Low Off Exchange Plan","71.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420001","Blue Dental PPO Plus SG 100/80/50?","15560MI042","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$29.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0420001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350001","Blue Cross� Premier Value","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,170","$0","$0","$150","$4,970","$90","$0","$40","4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350001","Blue Cross� Premier Value","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Catastrophic","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$6,170","$0","$0","$150","$4,970","$90","$0","$40","5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420002","Blue Dental PPO Plus SG 100/80/50?","15560MI042","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$29.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0420002-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0710001","Blue Dental PPO Plus Personal?","15560MI071","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$27.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0710001-01","Standard Low On Exchange Plan","71.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420003","Blue Dental PPO Plus SG 90/50/50?","15560MI042","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$23.63",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0420003-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","25"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-03","Limited Cost Sharing Plan Variation",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","26"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-04","73% AV Level Silver Plan",,"0.737727880477905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","27"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0720001","Blue Dental PPO Personal?","15560MI072","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,200 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$22.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0720001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross� Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$40","8"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0420005","Blue Dental PPO Plus SG 80/60/50?","15560MI042","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$23.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0420005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040002","McLaren Rewards Gold","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040009","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040002-03","Limited Cost Sharing Plan Variation",,"0.802020967006683","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","Not Applicable","Not Applicable","$4,000","$8,000","$1,000","$2,000","25%","$1,000","$2,000","25%","Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-01","Standard Silver On Exchange Plan",,"0.682338953018188","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","40%","$2,000","$4,000","40%","Not Applicable","Not Applicable","$2,000","$4,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-03","Limited Cost Sharing Plan Variation",,"0.682338953018188","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","40%","$2,000","$4,000","40%","Not Applicable","Not Applicable","$2,000","$4,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-05","87% AV Level Silver Plan",,"0.875726521015167","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$0","$500","$0","$500","$375","$125","$0","46"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-06","94% AV Level Silver Plan",,"0.942822754383087","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","47"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","4","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370014","Priority Health PPO HSA  Silver 1500","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/571715FB032140DA80E1DA08C04BB695.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370014-01","Standard Silver On Exchange Plan",,"0.718804240226746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-00","Standard Silver Off Exchange Plan",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550001","Priority Health HMO - 100 Platinum 250","29698MI055",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/304458114FF4478DAA3E361CB68F0F69.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550001-00","Standard Platinum Off Exchange Plan",,"0.894584715366364","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-01","Standard Silver On Exchange Plan",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","5"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550001","Priority Health HMO - 100 Platinum 250","29698MI055",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/304458114FF4478DAA3E361CB68F0F69.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550001-01","Standard Platinum On Exchange Plan",,"0.894584715366364","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550002","Priority Health HMO - 90 Platinum 250","29698MI055",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/3E203EC8AE3C46609464C8A12131907A.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550002-00","Standard Platinum Off Exchange Plan",,"0.896267175674438","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Personal?","15560MI073","7538162760","MIN002","MIS002",,"New","EPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$20.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0730001-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350002","Blue Cross� Premier Bronze","15560MI035","7538162760","MIN001","MIS001","MIF051","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350002-03","Limited Cost Sharing Plan Variation","58.70%","0.579830527305603","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,670","$500","$0","$150","$5,260","$0","$0","$40","9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440001","Blue Dental PPO SG 100/80/50 (80/50/50)?","15560MI044","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$24.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0440001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","Yes","38-2069753","15560MI0730001","Blue Dental EPO Personal?","15560MI073","7538162760","MIN002","MIS002",,"New","EPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$20.23",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/dental-brochures",,"15560MI0730001-01","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0440002","Blue Dental PPO SG 100/80/50 (50/50/50)?","15560MI044","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$21.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0440002-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-05","87% AV Level Silver Plan","86.10%","0.864746272563934","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$2,800","$5,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$300","$500","$540","$150","$300","$180","$430","$40","15"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","1","15560","MI","Individual","No","38-2069753","15560MI0350003","Blue Cross� Premier Silver","15560MI035","7538162760","MIN001","MIS001","MIF052","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","All Covered Benefits","Yes","http://www.bcbsm.com/sbc",,"http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0350003-06","94% AV Level Silver Plan","93.10%","0.931599736213684","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","10%",,,,"$350","$700","Not Applicable","Not Applicable","$175","$0","$325","$150","$175","$180","$145","$40","16"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0430005","Blue Dental PPO Plus SG 80/60/50/50?","15560MI043","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$23.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0430005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450001","Blue Dental PPO SG 100/80/50/50 (80/50/50/50)?","15560MI045","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,250 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$24.49",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0450001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450002","Blue Dental PPO SG 100/80/50/50 (50/50/50/50)?","15560MI045","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,500 annual benefit maximum for members age 19 or older when coverage begins. $1,500 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$21.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0450002-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270063","MyPriority MyHealth Access Gold 1000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/635492A099A04428B57395926EA24030.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270063-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270063","MyPriority MyHealth Access Gold 1000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/635492A099A04428B57395926EA24030.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270063-03","Limited Cost Sharing Plan Variation",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","18"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040009","McLaren Rewards Gold Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040009","McLaren Rewards Gold Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040009-03","Limited Cost Sharing Plan Variation",,"0.802020967006683","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","Not Applicable","Not Applicable","$4,000","$8,000","$1,000","$2,000","25%","$1,000","$2,000","25%","Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-01","Standard Silver On Exchange Plan",,"0.682338953018188","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","40%","$2,000","$4,000","40%","Not Applicable","Not Applicable","$2,000","$4,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"26"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-00","Standard Silver Off Exchange Plan",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","23"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-01","Standard Silver On Exchange Plan",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","24"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-05","87% AV Level Silver Plan",,"0.869832098484039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","20%",,,,"$800","$1,600","Not Applicable","Not Applicable","$400","$0","$800","$0","$400","$400","$400","$0","28"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-03","Limited Cost Sharing Plan Variation",,"0.682338953018188","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","40%","$2,000","$4,000","40%","Not Applicable","Not Applicable","$2,000","$4,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-04","73% AV Level Silver Plan",,"0.724697053432465","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","Not Applicable","Not Applicable","$4,500","$9,000","$1,500","$3,000","40%","$1,500","$3,000","40%","Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270064","MyPriority MyHealth Access Bronze 5000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/9A935914E571458D9161A609E872F642.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270064","MyPriority MyHealth Access Bronze 5000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/9A935914E571458D9161A609E872F642.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270064-03","Limited Cost Sharing Plan Variation",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","22"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270065","MyPriority MyHealth Access Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/4A67274D6A20405781F8CF5396B2C628.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270065-06","94% AV Level Silver Plan",,"0.943774878978729","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$800","$1,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$200","$400","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","29"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-00","Standard Silver Off Exchange Plan",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","30"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-01","Standard Silver On Exchange Plan",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","31"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","32"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-03","Limited Cost Sharing Plan Variation",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","33"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-04","73% AV Level Silver Plan",,"0.737727880477905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","34"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-05","87% AV Level Silver Plan",,"0.863887012004852","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$4,000","$500","$1,000","20%","$500","$1,000","20%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040010","McLaren Rewards Silver Child Only","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040010-06","94% AV Level Silver Plan",,"0.946612298488617","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","Not Applicable","Not Applicable","$750","$1,500","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","$0","$0","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450003","Blue Dental PPO SG 100/80/50/50 (50/50/50/50)?","15560MI045","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$21.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0450003-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$75","$225","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450004","Blue Dental PPO SG 80/60/50/50 (50/50/50/50)?","15560MI045","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$18.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0450004-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0450005","Blue Dental PPO SG 80/60/50/50 (50/50/50/50)?","15560MI045","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$800 annual benefit maximum for members age 19 or older when coverage begins. $800 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$18.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0450005-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","2","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0470001","Blue Dental EPO SG 100/80/50/50?","15560MI047","7538162760","MIN002","MIS002",,"New","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. $1,250 lifetime orthodontic benefit maximum for members up to age 19. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$21.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0470001-00","Standard High Off Exchange Plan","86.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","3","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0480002","Blue Dental PPO Plus SG 80/60/50 Pediatric?","15560MI048","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0480002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490001","Blue Dental PPO Plus Voluntary SG 100/80/50?","15560MI049","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$33.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0490001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus Voluntary SG 90/50/50?","15560MI049","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$25.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0490002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0490002","Blue Dental PPO Plus Voluntary SG 90/50/50?","15560MI049","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Both",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins.",,,,,"Allows Adult and Child-Only",,,,"$25.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0490002-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0370003","Simply Blue Gold $1500","15560MI037","7538162760","MIN001","MIS001","MIF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employer/sbc/simply-blue-gold-370003","http://www.bcbsm.com/employer-enrollment","http://www.bcbsm.com/employer-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0370003-00","Standard Gold Off Exchange Plan","78.40%","0.781336724758148","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,150","$150","$1,500","$680","$120","$80","6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0370003","Simply Blue Gold $1500","15560MI037","7538162760","MIN001","MIS001","MIF009","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employer/sbc/simply-blue-gold-370003","http://www.bcbsm.com/employer-enrollment","http://www.bcbsm.com/employer-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0370003-01","Standard Gold On Exchange Plan","78.40%","0.781336724758148","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$20","$1,150","$150","$1,500","$680","$120","$80","7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660001","Blue Dental PPO Voluntary SG 100/80/50 (80/50/50)?","15560MI066","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$26.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0660001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$50","$150","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660002","Blue Dental PPO Voluntary SG 100/80/50 (80/50/50)?","15560MI066","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$26.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0660002-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$50","$150","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0660003","Blue Dental PPO Voluntary SG 80/60/50 (50/50/50)?","15560MI066","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist.",,,,,"Allows Adult and Child-Only",,,,"$21.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0660003-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","4","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0680001","Blue Dental EPO Voluntary SG 100/80/50?","15560MI068","7538162760","MIN002","MIS002",,"New","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$24.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0680001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0650001","Blue Dental PPO Plus Voluntary SG 100/80/50/50?","15560MI065","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$33.33",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0650001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0650002","Blue Dental PPO Plus Voluntary SG 90/50/50/50?","15560MI065","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$25.64",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0650002-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670001","Blue Dental�PPO Voluntary SG 100/80/50/50 (80/50/50/50)?","15560MI067","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$26.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0670001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$50","$150","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670002","Blue Dental PPO Voluntary SG 100/80/50/50 (80/50/50/50)?","15560MI067","7538162760","MIN002","MIS001",,"New","PPO","High",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$26.94",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0670002-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$50","$150","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0670003","Blue Dental PPO Voluntary SG 80/60/50/50 (50/50/50/50)?","15560MI067","7538162760","MIN002","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,"$1,000 annual benefit maximum for for members age 19 or older when coverage begins, of which no more than $800 can be used for services provided by a non-PPO (out-of-network) dentist. $1,000 lifetime orthodontic benefit maximum for members up to age 19.",,,,,"Allows Adult and Child-Only",,,,"$21.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0670003-00","Standard Low Off Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","5","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0690001","Blue Dental EPO Voluntary SG 100/80/50/50?","15560MI069","7538162760","MIN002","MIS002",,"New","EPO","High",,"Off the Exchange",,,,"$1,250 annual benefit maximum for members age 19 or older when coverage begins. $1,000 lifetime orthodontic benefit maximum for members up to age 19. Plan excludes coverage for services performed by non-PPO (out-of-network) dentists.",,,,,"Allows Adult and Child-Only",,,,"$24.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","No",,"Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0690001-00","Standard High Off Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","6","15560","MI","SHOP (Small Group)","Yes","38-2069753","15560MI0700001","Blue Dental PPO Plus Voluntary SG 80/60/50 Pediatric?","15560MI070","7538162760","MIN002","MIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.83",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Any licensed dentist in the country can participate with us on a per-claim basis through our Blue Par Select arrangement.  Like PPO network dentists, Blue Par Select dentists accept the Blues� approved amount as full payment for covered services, less your plan�s deductible or any copay.","Yes",,,"http://www.bcbsm.com/employer-dental-plan-brochures",,"15560MI0700001-01","Standard Low On Exchange Plan","69.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","10","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA Silver $2000 ($0)","15560MI039","7538162760","MIN001","MIS001","MIF021","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employer/sbc/simply-blue-hsa-silver-390003","http://www.bcbsm.com/employer-enrollment","http://www.bcbsm.com/employer-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0390003-00","Standard Silver Off Exchange Plan","68.70%","0.68443089723587","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,050","$150","$2,000","$440","$260","$80","6"
"2014","MI","15560","SERFF","8","2013-11-27 09:24:34","10","15560","MI","SHOP (Small Group)","No","38-2069753","15560MI0390003","Simply Blue HSA Silver $2000 ($0)","15560MI039","7538162760","MIN001","MIS001","MIF021","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pain Management",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Coverage provided through BlueCard Worldwide program","Yes","Out of service area coverage provided through BlueCard PPO program","Yes","http://www.bcbsm.com/employer/sbc/simply-blue-hsa-silver-390003","http://www.bcbsm.com/employer-enrollment","http://www.bcbsm.com/employer-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-ppo","15560MI0390003-01","Standard Silver On Exchange Plan","68.70%","0.68443089723587","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$20","$1,050","$150","$2,000","$440","$260","$80","7"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","SHOP (Small Group)","No","38-3252216","20393MI0010001","McLaren Rewards Platinum","20393MI001",,"MIN001","MIS001","MIF004","New","HMO","Platinum","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise requires Out of Area Waiver from Plan","Yes","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.mclarenhealthplan.org","20393MI0010001-01","Standard Platinum On Exchange Plan",,"0.899350225925446","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000","$500","$1,000","10%","$500","$1,000","10%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040001","McLaren Rewards Platinum","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040008","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040001-01","Standard Platinum On Exchange Plan",,"0.899350225925446","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000","$500","$1,000","10%","$500","$1,000","10%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","SHOP (Small Group)","No","38-3252216","20393MI0010002","McLaren Rewards Gold","20393MI001",,"MIN001","MIS001","MIF004","New","HMO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise requires Out of Area Waiver from Plan","Yes","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.mclarenhealthplan.org","20393MI0010002-01","Standard Gold On Exchange Plan",,"0.802020967006683","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","Not Applicable","Not Applicable","$4,000","$8,000","$1,000","$2,000","25%","$1,000","$2,000","25%","Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040001","McLaren Rewards Platinum","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040008","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","SHOP (Small Group)","No","38-3252216","20393MI0010003","McLaren Rewards Silver","20393MI001",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise requires Out of Area Waiver from Plan","Yes","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.McLarenHealthPlan.org","www.mclarenhealth.org","20393MI0010003-01","Standard Silver On Exchange Plan",,"0.682338953018188","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","40%","$2,000","$4,000","40%","Not Applicable","Not Applicable","$2,000","$4,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040001","McLaren Rewards Platinum","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040008","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040001-03","Limited Cost Sharing Plan Variation",,"0.899350225925446","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000","$500","$1,000","10%","$500","$1,000","10%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040002","McLaren Rewards Gold","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040009","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040002-01","Standard Gold On Exchange Plan",,"0.802020967006683","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","Not Applicable","Not Applicable","$4,000","$8,000","$1,000","$2,000","25%","$1,000","$2,000","25%","Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040002","McLaren Rewards Gold","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040009","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-04","73% AV Level Silver Plan",,"0.724697053432465","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","Not Applicable","Not Applicable","$4,500","$9,000","$1,500","$3,000","40%","$1,500","$3,000","40%","Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-05","87% AV Level Silver Plan",,"0.863887012004852","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","Not Applicable","Not Applicable","$2,000","$4,000","$500","$1,000","20%","$500","$1,000","20%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040003","McLaren Rewards Silver","20393MI004",,"MIN001","MIS001","MIF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","20393MI0040010","No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040003-06","94% AV Level Silver Plan",,"0.946612298488617","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","Not Applicable","Not Applicable","$750","$1,500","$0","$0","10%","$0","$0","10%","Not Applicable","Not Applicable","$0","$0","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040008","McLaren Rewards Platinum Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040008-01","Standard Platinum On Exchange Plan",,"0.899350225925446","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000","$500","$1,000","10%","$500","$1,000","10%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040008","McLaren Rewards Platinum Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040008-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"20"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040008","McLaren Rewards Platinum Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Platinum","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040008-03","Limited Cost Sharing Plan Variation",,"0.899350225925446","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000","$500","$1,000","10%","$500","$1,000","10%","Not Applicable","Not Applicable","$500","$1,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","MI","20393","SERFF","7","2013-11-27 09:24:34","1","20393","MI","Individual","No","38-3252216","20393MI0040009","McLaren Rewards Gold Child Only","20393MI004",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"No",,,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency or Otherwise Requires Out Of Area Waiver From Plan","Yes","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","www.mclarenhealthplan.org","20393MI0040009-01","Standard Gold On Exchange Plan",,"0.802020967006683","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","Not Applicable","Not Applicable","$4,000","$8,000","$1,000","$2,000","25%","$1,000","$2,000","25%","Not Applicable","Not Applicable","$1,000","$2,000","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270064","MyPriority MyHealth Access Bronze 5000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/9A935914E571458D9161A609E872F642.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270064-00","Standard Bronze Off Exchange Plan",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","19"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270064","MyPriority MyHealth Access Bronze 5000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/9A935914E571458D9161A609E872F642.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270064-01","Standard Bronze On Exchange Plan",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","20"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-05","87% AV Level Silver Plan",,"0.869832098484039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","20%",,,,"$800","$1,600","Not Applicable","Not Applicable","$400","$0","$1,100","$0","$400","$400","$700","$0","35"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270066","MyPriority MyHealth Access Silver 1500","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/562BC5F8E5804A6D93FFD1C4374A0CA1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270066-06","94% AV Level Silver Plan",,"0.943774878978729","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$800","$1,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$200","$400","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","36"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270067","MyPriority Access HSA Bronze 6000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270064","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/B18A43FCBAE544819A3FD943729A14FE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270067-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","37"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270067","MyPriority Access HSA Bronze 6000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270064","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/B18A43FCBAE544819A3FD943729A14FE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270067-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","38"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270067","MyPriority Access HSA Bronze 6000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270064","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/B18A43FCBAE544819A3FD943729A14FE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270067-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","39"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270067","MyPriority Access HSA Bronze 6000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270064","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/B18A43FCBAE544819A3FD943729A14FE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270067-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","40"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-00","Standard Silver Off Exchange Plan",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","41"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-01","Standard Silver On Exchange Plan",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","42"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","43"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-03","Limited Cost Sharing Plan Variation",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","44"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-04","73% AV Level Silver Plan",,"0.735042273998261","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","45"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-05","87% AV Level Silver Plan",,"0.875726521015167","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$0","$500","$0","$500","$375","$125","$0","46"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270068","MyPriority Access HSA Silver 2000","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270066","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/69484B0CDE854BBA9FD98833BE1ADED0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270068-06","94% AV Level Silver Plan",,"0.942822754383087","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$800","$1,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"$200","$400","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","47"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270069","MyPriority Access HSA Gold 1250","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/7E21B658C3A34CCB88A25DD45DF5A5CB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270069-00","Standard Gold Off Exchange Plan",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","48"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270069","MyPriority Access HSA Gold 1250","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/7E21B658C3A34CCB88A25DD45DF5A5CB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270069-01","Standard Gold On Exchange Plan",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","49"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270069","MyPriority Access HSA Gold 1250","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/7E21B658C3A34CCB88A25DD45DF5A5CB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270069-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","50"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","1","29241","MI","Individual","No","20-1529553","29241MI0270069","MyPriority Access HSA Gold 1250","29241MI027",,"MIN001","MIS001","MIF005","New","PPO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29241MI0270063","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","Yes","http://www.priorityhealth.com/~/media/7E21B658C3A34CCB88A25DD45DF5A5CB.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0270069-03","Limited Cost Sharing Plan Variation",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"$2,500","$5,000","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","51"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","2","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370007","Priority Health PPO VP Silver 1500","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/D1245434E28E4A7C8A5E237DEBEC3D97.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370007-00","Standard Silver Off Exchange Plan",,"0.71535587310791","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","2","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370007","Priority Health PPO VP Silver 1500","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/D1245434E28E4A7C8A5E237DEBEC3D97.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370007-01","Standard Silver On Exchange Plan",,"0.71535587310791","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","2","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370008","Priority Health PPO VP Silver 2000","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/FC280A72628D4977B4CA23F95358E6CE.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370008-00","Standard Silver Off Exchange Plan",,"0.687363922595978","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-06","94% AV Level Silver Plan",,"0.943774878978729","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","36"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540007","MyPriority HSA Bronze 6000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/96CE6443EF3045DF8DC53669173B97C0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540007-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","37"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540007","MyPriority HSA Bronze 6000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/96CE6443EF3045DF8DC53669173B97C0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540007-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","38"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540007","MyPriority HSA Bronze 6000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/96CE6443EF3045DF8DC53669173B97C0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","39"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540007","MyPriority HSA Bronze 6000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540004","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/96CE6443EF3045DF8DC53669173B97C0.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540007-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$0","$0","$6,000","$0","$0","$0","40"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","2","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370008","Priority Health PPO VP Silver 2000","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.993945614213188",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/FC280A72628D4977B4CA23F95358E6CE.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370008-01","Standard Silver On Exchange Plan",,"0.687363922595978","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","4","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370012","Priority Health PPO HSA Gold 1250 2-tier Rx","29241MI037",,"MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/2E81C32F9FE345789920286827104087.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370012-00","Standard Gold Off Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","4","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370012","Priority Health PPO HSA Gold 1250 2-tier Rx","29241MI037",,"MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/2E81C32F9FE345789920286827104087.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370012-01","Standard Gold On Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","29241","SERFF","7","2014-03-18 09:48:59","4","29241","MI","SHOP (Small Group)","No","20-1529553","29241MI0370014","Priority Health PPO HSA  Silver 1500","29241MI037",,"MIN001","MIS001","MIF003","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","Yes","http://www.priorityhealth.com/~/media/571715FB032140DA80E1DA08C04BB695.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29241MI0370014-00","Standard Silver Off Exchange Plan",,"0.718804240226746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$7,200","$14,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","43"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-03","Limited Cost Sharing Plan Variation",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","44"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-04","73% AV Level Silver Plan",,"0.735042273998261","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","45"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-03","Limited Cost Sharing Plan Variation",,"0.688295423984528","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,500","$0","$1,500","$0","$2,500","$900","$600","$0","7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-01","Standard Silver On Exchange Plan",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","24"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","25"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-03","Limited Cost Sharing Plan Variation",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","26"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-04","73% AV Level Silver Plan",,"0.737727880477905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","27"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-05","87% AV Level Silver Plan",,"0.869832098484039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$0","$800","$0","$400","$400","$400","$0","28"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-06","94% AV Level Silver Plan",,"0.943774878978729","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$0","$300","$0","$100","$300","$0","$0","29"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-00","Standard Silver Off Exchange Plan",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","30"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550002","Priority Health HMO - 90 Platinum 250","29698MI055",,"MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/3E203EC8AE3C46609464C8A12131907A.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550002-01","Standard Platinum On Exchange Plan",,"0.896267175674438","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-04","73% AV Level Silver Plan",,"0.729930698871613","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$1,800","$0","$1,500","$900","$900","$0","8"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550003","Priority Health HMO Gold 500 2-tier Rx","29698MI055",,"MIN001","MIS001","MIF004","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/F02C3473CF3E406A9054849C85DA2157.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550003-00","Standard Gold Off Exchange Plan",,"0.819545030593872","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550003","Priority Health HMO Gold 500 2-tier Rx","29698MI055",,"MIN001","MIS001","MIF004","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/F02C3473CF3E406A9054849C85DA2157.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550003-01","Standard Gold On Exchange Plan",,"0.819545030593872","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-05","87% AV Level Silver Plan",,"0.877419531345367","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$0","$1,000","$0","$250","$900","$100","$0","9"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540001","MyPriority MyHealth Silver 2500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/3D2B1934C09946AA87AED1732AD364F6.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540001-06","94% AV Level Silver Plan",,"0.948239982128143","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$0","$300","$0","$100","$300","$0","$0","10"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560001","Priority Health POS - 100 Platinum 250","29698MI056",,"MIN001","MIS001","MIF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/1A0812740E3B4609A30B27065F473225.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560001-00","Standard Platinum Off Exchange Plan",,"0.894584715366364","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560001","Priority Health POS - 100 Platinum 250","29698MI056",,"MIN001","MIS001","MIF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/1A0812740E3B4609A30B27065F473225.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560001-01","Standard Platinum On Exchange Plan",,"0.894584715366364","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$5,000","$10,000","Not Applicable","Not Applicable","$250","$500","0%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560002","Priority Health POS - 90 Platinum 250","29698MI056",,"MIN001","MIS001","MIF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/35519608A1A043B19C0A40E02CB03F6C.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560002-00","Standard Platinum Off Exchange Plan",,"0.896267175674438","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400","Not Applicable","Not Applicable","$250","$500","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560002","Priority Health POS - 90 Platinum 250","29698MI056",,"MIN001","MIS001","MIF001","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/35519608A1A043B19C0A40E02CB03F6C.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560002-01","Standard Platinum On Exchange Plan",,"0.896267175674438","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$2,200","$4,400","Not Applicable","Not Applicable","$250","$500","10%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560003","Priority Health POS Gold 500 2-tier Rx","29698MI056",,"MIN001","MIS001","MIF004","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/B85580ED647647F99C2B7CABC85E6A6D.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560003-00","Standard Gold Off Exchange Plan",,"0.819545030593872","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","2","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560003","Priority Health POS Gold 500 2-tier Rx","29698MI056",,"MIN001","MIS001","MIF004","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/B85580ED647647F99C2B7CABC85E6A6D.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560003-01","Standard Gold On Exchange Plan",,"0.819545030593872","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","3","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550007","Priority Health HMO VP Silver 1500","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Child Dependent Coverage","No","http://www.priorityhealth.com/~/media/02C0B794EEE74540823D39A7FB347422.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550007-00","Standard Silver Off Exchange Plan",,"0.71535587310791","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","3","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550007","Priority Health HMO VP Silver 1500","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Child Dependent Coverage","No","http://www.priorityhealth.com/~/media/02C0B794EEE74540823D39A7FB347422.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550007-01","Standard Silver On Exchange Plan",,"0.71535587310791","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010004","BEST Dental Plus - Gold","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Plus_Plan_(Gold).pdf",,"35700MI0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020004","BESTOne Dental Plus - Gold","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"35700MI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010004","BEST Dental Plus - Gold","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Plus_Plan_(Gold).pdf",,"35700MI0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","38791","SERFF","3","2013-08-23 12:24:02","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0040001","EHB Low PPO","38791MI004",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.08",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"38791MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-03","Limited Cost Sharing Plan Variation",,"0.680449903011322","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$2,500","$5,000","20%",,,,"$0","$0","$2,500","$5,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-04","73% AV Level Silver Plan",,"0.736137211322784","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$0","$0","$5,000","$10,000","$2,500","$5,000","20%",,,,"$0","$0","$2,500","$5,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","3","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550008","Priority Health HMO VP Silver 2000","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Child Dependent Coverage","No","http://www.priorityhealth.com/~/media/6555942B84A342E1A2C7DC2A3C2D1539.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550008-00","Standard Silver Off Exchange Plan",,"0.687363922595978","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","3","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550008","Priority Health HMO VP Silver 2000","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Child Dependent Coverage","No","http://www.priorityhealth.com/~/media/6555942B84A342E1A2C7DC2A3C2D1539.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550008-01","Standard Silver On Exchange Plan",,"0.687363922595978","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550005","Priority Health HMO Gold 1000","29698MI055",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/7DDD8BEF15374891BA6BC57ED723BD29.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550005-00","Standard Gold Off Exchange Plan",,"0.788382112979889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540002","MyPriority MyHealth Gold 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/D40341E29223439EB67A549C199A8E27.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540002-00","Standard Gold Off Exchange Plan",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","11"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540002","MyPriority MyHealth Gold 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/D40341E29223439EB67A549C199A8E27.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540002-01","Standard Gold On Exchange Plan",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","12"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550005","Priority Health HMO Gold 1000","29698MI055",,"MIN001","MIS001","MIF002","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992687880615507",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care; Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/7DDD8BEF15374891BA6BC57ED723BD29.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550005-01","Standard Gold On Exchange Plan",,"0.788382112979889","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540002","MyPriority MyHealth Gold 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/D40341E29223439EB67A549C199A8E27.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540002","MyPriority MyHealth Gold 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/D40341E29223439EB67A549C199A8E27.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540002-03","Limited Cost Sharing Plan Variation",,"0.790924847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$0","$600","$0","$1,500","$900","$100","$0","14"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540003","MyPriority MyHealth Gold 1000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/B9205ED88EE04BB284C5071F8B8B99DA.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540003-00","Standard Gold Off Exchange Plan",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","15"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540003","MyPriority MyHealth Gold 1000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/B9205ED88EE04BB284C5071F8B8B99DA.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540003-01","Standard Gold On Exchange Plan",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","16"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540003","MyPriority MyHealth Gold 1000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/B9205ED88EE04BB284C5071F8B8B99DA.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540003","MyPriority MyHealth Gold 1000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/B9205ED88EE04BB284C5071F8B8B99DA.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540003-03","Limited Cost Sharing Plan Variation",,"0.809434235095978","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$650","$0","$1,000","$900","$350","$0","18"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540004","MyPriority MyHealth Bronze 5000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7ED8F6D7A5BC4648A738C77CAECC00B1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540004-00","Standard Bronze Off Exchange Plan",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","19"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540004","MyPriority MyHealth Bronze 5000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7ED8F6D7A5BC4648A738C77CAECC00B1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540004-01","Standard Bronze On Exchange Plan",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","20"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540004","MyPriority MyHealth Bronze 5000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7ED8F6D7A5BC4648A738C77CAECC00B1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540004","MyPriority MyHealth Bronze 5000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7ED8F6D7A5BC4648A738C77CAECC00B1.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540004-03","Limited Cost Sharing Plan Variation",,"0.612954795360565","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$0","$750","$0","$5,000","$0","$0","$0","22"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540005","MyPriority MyHealth Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/8EA3AE72657E419A891108EDD9AD308A.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540005-00","Standard Silver Off Exchange Plan",,"0.689320087432861","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$640","$0","23"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-01","Standard Silver On Exchange Plan",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","31"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","32"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-03","Limited Cost Sharing Plan Variation",,"0.711709201335907","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","33"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-04","73% AV Level Silver Plan",,"0.737727880477905","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$0","$1,200","$0","$1,500","$250","$730","$0","34"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540006","MyPriority MyHealth Silver 1500","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","4","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/7E41C0CCF9EA405586A96ECF1CE15F32.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/3B5A02A226EA46CB885F4833594D5E99.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540006-05","87% AV Level Silver Plan",,"0.869832098484039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$0","$1,100","$0","$400","$400","$700","$0","35"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-00","Standard Silver Off Exchange Plan",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","41"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540008","MyPriority HSA Silver 2000","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540006","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/A901869D904B476E8BC6FFD39ACB6AD3.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540008-01","Standard Silver On Exchange Plan",,"0.689321994781494","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$0","$1,100","$0","$2,000","$200","$1,036","$0","42"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540009","MyPriority HSA Gold 1250","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/07A627ACEE614AB78401A95E5E0BE562.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540009-00","Standard Gold Off Exchange Plan",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","48"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540009","MyPriority HSA Gold 1250","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/07A627ACEE614AB78401A95E5E0BE562.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540009-01","Standard Gold On Exchange Plan",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","49"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540009","MyPriority HSA Gold 1250","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/07A627ACEE614AB78401A95E5E0BE562.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","50"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540009","MyPriority HSA Gold 1250","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Gold","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/07A627ACEE614AB78401A95E5E0BE562.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/DF082B54BE6A43A792365539431D50EF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540009-03","Limited Cost Sharing Plan Variation",,"0.787009239196777","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$0","$625","$0","$1,250","$300","$450","$0","51"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540010","MyPriority Vida","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/60FD104B8AC54E01B23A3C71A5B109BE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/903292E1D669494FA37C7796F599BABF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$6,350","$0","$0","$0","52"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","1","29698","MI","Individual","No","38-2715520","29698MI0540010","MyPriority Vida","29698MI054",,"MIN001","MIS001","MIF005","New","HMO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult-Only","29698MI0540003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Care Only","Yes","Urgent/Emergency Care Only","No","http://www.priorityhealth.com/~/media/60FD104B8AC54E01B23A3C71A5B109BE.pdf","https://sso.priorityhealth.com/sp/ACS.saml2?RelayState=https%3A%2F%2Fwww.priorityhealth.com%2Fapp%2FFederalPaymentCollection","http://www.priorityhealth.com/~/media/903292E1D669494FA37C7796F599BABF.pdf","https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0540010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$6,350","$0","$0","$0","53"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220008","1500 (HSA)","37651MI022","7851394099","MIN001","MIS001","MIF009","New","HMO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114536",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1500hmohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220008-00","Standard Gold Off Exchange Plan",,"0.796283841133118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$0","$0","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$0","$0","$1,500","$3,000",,,,,,,,,"4"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220008","1500 (HSA)","37651MI022","7851394099","MIN001","MIS001","MIF009","New","HMO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114536",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1500hmohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220008-01","Standard Gold On Exchange Plan",,"0.796283841133118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$0","$0","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$0","$0","$1,500","$3,000",,,,,,,,,"5"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","Individual","No","38-2242827","37651MI0150007","Personal Alliance 5000","37651MI015","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-5000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150007-01","Standard Bronze On Exchange Plan",,"0.611270546913147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$5,000","$10,000","20%",,,,"$0","$0","$5,000","$10,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","Individual","No","38-2242827","37651MI0150007","Personal Alliance 5000","37651MI015","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-5000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220010","2000 (HSA)","37651MI022","7851394099","MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114578",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000hmohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220010-00","Standard Silver Off Exchange Plan",,"0.696801781654358","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$0","$0","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$0","$0","$2,000","$4,000",,,,,,,,,"7"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","Individual","No","38-2242827","37651MI0150007","Personal Alliance 5000","37651MI015","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-5000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150007-03","Limited Cost Sharing Plan Variation",,"0.611270546913147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$5,000","$10,000","20%",,,,"$0","$0","$5,000","$10,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220010","2000 (HSA)","37651MI022","7851394099","MIN001","MIS001","MIF006","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114578",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000hmohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220010-01","Standard Silver On Exchange Plan",,"0.696801781654358","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$0","$0","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$0","$0","$2,000","$4,000",,,,,,,,,"8"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","3","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220012","3000","37651MI022","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98956184311454",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-3000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220012-00","Standard Bronze Off Exchange Plan",,"0.601797103881836","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$0","$0","$3,000","$6,000",,,,,,,,,"4"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","3","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220012","3000","37651MI022","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.98956184311454",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-3000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220012-01","Standard Bronze On Exchange Plan",,"0.601797103881836","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$0","$0","$3,000","$6,000",,,,,,,,,"5"
"2014","MI","38791","SERFF","3","2013-08-23 12:24:02","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0040002","EHB High PPO","38791MI004",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"38791MI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020003","BESTOne Dental Advantage - Gold","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"35700MI0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020003","BESTOne Dental Advantage - Gold","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"35700MI0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010003","BEST Dental Advantage - Gold","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Advantage_Plan_(Gold).pdf",,"35700MI0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-05","87% AV Level Silver Plan",,"0.866551399230957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$0","$0","$1,500","$3,000","$500","$1,000","0%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-06","94% AV Level Silver Plan",,"0.930617272853851","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$0","$0","$750","$1,500","$100","$200","0%",,,,"$0","$0","$100","$200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","2","37651","MI","Individual","No","38-2242827","37651MI0150007","Personal Alliance 5000","37651MI015","7851394099","MIN001","MIS001","MIF005","New","HMO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-5000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150007-00","Standard Bronze Off Exchange Plan",,"0.611270546913147","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$5,000","$10,000","20%",,,,"$0","$0","$5,000","$10,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Connect Platinum 1000/1500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104687","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059174","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150001","Personal Alliance 500","37651MI015","7851394099","MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105016",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150001-01","Standard Platinum On Exchange Plan",,"0.880376398563385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$0","$0","$1,500","$3,000","$500","$1,000","20%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220002","500","37651MI022","7851394099","MIN001","MIS001","MIF007","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114537",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220002-01","Standard Platinum On Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$0","$0","$1,000","$2,000","$500","$1,000","0%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150001","Personal Alliance 500","37651MI015","7851394099","MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105016",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150001","Personal Alliance 500","37651MI015","7851394099","MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105016",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150001-03","Limited Cost Sharing Plan Variation",,"0.880376398563385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$0","$0","$1,500","$3,000","$500","$1,000","20%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220004","1000","37651MI022","7851394099","MIN001","MIS001","MIF008","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114536",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220004-00","Standard Gold Off Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150003","Personal Alliance 1000","37651MI015","7851394099","MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-1000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150003-01","Standard Gold On Exchange Plan",,"0.797409057617188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220004","1000","37651MI022","7851394099","MIN001","MIS001","MIF008","New","HMO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114536",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220004-01","Standard Gold On Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150003","Personal Alliance 1000","37651MI015","7851394099","MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-1000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150003","Personal Alliance 1000","37651MI015","7851394099","MIN001","MIS001","MIF002","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-1000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150003-03","Limited Cost Sharing Plan Variation",,"0.797409057617188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220006","2000","37651MI022","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114578",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220006-00","Standard Silver Off Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000","$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220006","2000","37651MI022","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114578",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220006-01","Standard Silver On Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000","$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150005","Personal Alliance 2500","37651MI015","7851394099","MIN001","MIS001","MIF004","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105015",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-2500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150005-01","Standard Silver On Exchange Plan",,"0.680449903011322","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$2,500","$5,000","20%",,,,"$0","$0","$2,500","$5,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","45002","SERFF","9","2013-10-15 10:04:03","1","45002","MI","SHOP (Small Group)","No","86-0207231","45002MI0140003","UnitedHealthcare Bronze HSA","45002MI014",,"MIN002","MIS001","MIF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopmi",,,"www.welcometouhc.com/shopmi","45002MI0140003-01","Standard Bronze On Exchange Plan","59.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$20","$500","$200","$5,000","$80","$0","$80","4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010005","Total Gold Premier","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010005.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010005-01","Standard Gold On Exchange Plan","81.80%","0.817814826965332","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-06","94% AV Level Silver Plan","94.40%","0.949047803878784","No","No","No","100%",,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550012","Priority Health HMO HSA Gold 1250 2-tier Rx","29698MI055",,"MIN001","MIS001","MIF004","New","HMO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/89152C191E9B42F5B73DD031193F7C4D.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550012-00","Standard Gold Off Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550012","Priority Health HMO HSA Gold 1250 2-tier Rx","29698MI055",,"MIN001","MIS001","MIF004","New","HMO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/89152C191E9B42F5B73DD031193F7C4D.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550012-01","Standard Gold On Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550014","Priority Health HMO HSA  Silver 1500","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/F97E718A2B344913817AD49D1405ABF8.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550014-00","Standard Silver Off Exchange Plan",,"0.718804240226746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550014","Priority Health HMO HSA  Silver 1500","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/F97E718A2B344913817AD49D1405ABF8.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550014-01","Standard Silver On Exchange Plan",,"0.718804240226746","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550016","Priority Health HMO HSA Bronze 3000","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/DCAAED7B566E474B9FF881A5AAF9FA54.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550016-00","Standard Bronze Off Exchange Plan",,"0.614561676979065","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","7","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0550016","Priority Health HMO HSA Bronze 3000","29698MI055",,"MIN001","MIS001","MIF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$400","0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Urgent/Emergency Care: Out of Area Dependent Coverage","No","http://www.priorityhealth.com/~/media/DCAAED7B566E474B9FF881A5AAF9FA54.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0550016-01","Standard Bronze On Exchange Plan",,"0.614561676979065","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","2","41895","MI","Individual","No","45-3758112","41895MI0010014","Consumers Mutual - Generation Y","41895MI001",,"MIN001","MIS050","MIF004","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010014-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010007","Total Gold Complete","67183MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010007.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010007-01","Standard Gold On Exchange Plan","81.40%","0.799303114414215","No","No","No","100%",,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,"$150",,,,"$80","5"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010008","Total Value Plus","67183MI001",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010008.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010008-00","Standard Silver Off Exchange Plan","72.00%","0.719764888286591","No","No","No","100%",,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,"$3,070",,,,"$2,450","6"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Connect Platinum 1000/1500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104687","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059174","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020008","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS008",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020008-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400005","1000","67577MI040","7760485905","MIN001","MIS001","MIF003","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-1000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400005-00","Standard Gold Off Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060005","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS005",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060005-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020005","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS005",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020005-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020002","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS002",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020002-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060002","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS002",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060002-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","8","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560012","Priority Health POS HSA Gold 1250 2-tier Rx","29698MI056",,"MIN001","MIS001","MIF004","New","POS","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/54B3377C26924E0397B7BDA3193C12AD.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560012-00","Standard Gold Off Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","29698","SERFF","9","2014-03-18 09:48:59","8","29698","MI","SHOP (Small Group)","No","38-2715520","29698MI0560012","Priority Health POS HSA Gold 1250 2-tier Rx","29698MI056",,"MIN001","MIS001","MIF004","New","POS","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Alternate/Out of Network Benefit Coverage","No","http://www.priorityhealth.com/~/media/54B3377C26924E0397B7BDA3193C12AD.pdf",,,"https://www.priorityhealth.com/prog/pharmacy/pharmacy.cgi","29698MI0560012-01","Standard Gold On Exchange Plan",,"0.800956547260284","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","Individual","Yes","38-1791480","34930MI0090001","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0090001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100001","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0100001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100002","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0100002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","Individual","Yes","38-1791480","34930MI0090002","Delta Dental Individual PPO, EHB Certified","34930MI009",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0090002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100003","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0100003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","1","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0100004","Delta Dental Group PPO, EHB Certified","34930MI010",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0100004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110001","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$32.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0110001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","Individual","Yes","38-1791480","34930MI0120001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0120001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110002","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0110002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","Individual","Yes","38-1791480","34930MI0120002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","34930MI012",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$27.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0120002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","75%","25%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110003","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$32.17",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0110003-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","34930","SERFF","1","2013-08-01 21:15:43","2","34930","MI","SHOP (Small Group)","Yes","38-1791480","34930MI0110004","Delta Dental Group Pediatric-Only PPO, EHB Certified","34930MI011",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$26.08",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"34930MI0110004-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020001","BESTOne Child Dental Plus","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Child_Dental_Plus_Plan.pdf",,"35700MI0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010001","BEST Life Child Dental Plus","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plus_Plan.pdf",,"35700MI0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020001","BESTOne Child Dental Plus","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Child_Dental_Plus_Plan.pdf",,"35700MI0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010001","BEST Life Child Dental Plus","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plus_Plan.pdf",,"35700MI0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010002","BEST Life Child Dental","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plan.pdf",,"35700MI0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020002","BESTOne Child Dental","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plan.pdf",,"35700MI0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020002","BESTOne Child Dental","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plan.pdf",,"35700MI0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010002","BEST Life Child Dental","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Child_Dental_Plan.pdf",,"35700MI0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010003","BEST Dental Advantage - Gold","35700MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Advantage_Plan_(Gold).pdf",,"35700MI0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020004","BESTOne Dental Plus - Gold","35700MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"35700MI0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020005","BESTOne Dental Plus - Silver","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"35700MI0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010005","BEST Dental Plus - Silver","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Plus_Plan_(Silver).pdf",,"35700MI0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010005","BEST Dental Plus - Silver","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Plus_Plan_(Silver).pdf",,"35700MI0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020005","BESTOne Dental Plus - Silver","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"35700MI0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020006","BESTOne Dental Basic - Silver","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"35700MI0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010006","BEST Dental Basic - Silver","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Basic_Plan_(Silver).pdf",,"35700MI0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","SHOP (Small Group)","Yes","95-6042390","35700MI0010006","BEST Dental Basic - Silver","35700MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BEST_Dental_Basic_Plan_(Silver).pdf",,"35700MI0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","MI","35700","SERFF","6","2014-01-22 11:51:12","1","35700","MI","Individual","Yes","95-6042390","35700MI0020006","BESTOne Dental Basic - Silver","35700MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.97",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/MI/pdf/MI_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"35700MI0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","Individual","No","38-2242827","37651MI0150001","Personal Alliance 500","37651MI015","7851394099","MIN001","MIS001","MIF001","New","HMO","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987733782105016",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-pa-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0150001-00","Standard Platinum Off Exchange Plan",,"0.880376398563385","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$0","$0","$1,500","$3,000","$500","$1,000","20%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","37651","SERFF","6","2013-11-27 09:24:34","1","37651","MI","SHOP (Small Group)","No","38-2242827","37651MI0220002","500","37651MI022","7851394099","MIN001","MIS001","MIF007","New","HMO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989561843114537",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-500hmo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","37651MI0220002-00","Standard Platinum Off Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$0","$0","$1,000","$2,000","$500","$1,000","0%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","45002","SERFF","9","2013-10-15 10:04:03","2","45002","MI","SHOP (Small Group)","No","86-0207231","45002MI0140001","UnitedHealthcare Gold Navigate PPO","45002MI014",,"MIN003","MIS001","MIF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All, except OBGYN and as state mandated",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopmi",,,"www.welcometouhc.com/shopmi","45002MI0140001-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$20","$0","$200","$1,100","$900","$0","$80","4"
"2014","MI","45002","SERFF","9","2013-10-15 10:04:03","2","45002","MI","SHOP (Small Group)","No","86-0207231","45002MI0140002","UnitedHealthcare Silver Navigate PPO","45002MI014",,"MIN003","MIS001","MIF001","New","POS","Silver","Yes","On the Exchange","No","Yes","All, except OBGYN and as state mandated",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","With network provider, same as other network benefits","Yes","www.welcometouhc.com/shopmi",,,"www.welcometouhc.com/shopmi","45002MI0140002-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$2,000","$20","$1,100","$200","$1,100","$900","$0","$80","5"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-06","94% AV Level Silver Plan","94.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-05","87% AV Level Silver Plan","88.00%","0.876555383205414","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","2","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010006","Total Gold Signature","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010006.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010006-00","Standard Gold Off Exchange Plan","81.40%","0.814409077167511","No","No","No","100%",,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","2","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010006","Total Gold Signature","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010006.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010006-01","Standard Gold On Exchange Plan","81.40%","0.814409077167511","No","No","No","100%",,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010007","Total Gold Complete","67183MI001",,"MIN001","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010007.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010007-00","Standard Gold Off Exchange Plan","81.40%","0.799303114414215","No","No","No","100%",,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,"$150",,,,"$80","4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010008","Total Value Plus","67183MI001",,"MIN001","MIS001","MIF003","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010008.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010008-01","Standard Silver On Exchange Plan","72.00%","0.719764888286591","No","No","No","100%",,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010009","Total Value Complete","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010009.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010009-00","Standard Silver Off Exchange Plan","71.80%","0.694453716278076","No","No","No","100%",,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","2","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020010","Consumers Mutual Choice HSA - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020010-00","Standard Silver Off Exchange Plan","70.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%","$2,000","$4,000","50%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","2","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020010","Consumers Mutual Choice HSA - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF002","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020010-01","Standard Silver On Exchange Plan","70.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%","$2,000","$4,000","50%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","2","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020011","Consumers Mutual Basic - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF003","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020011-00","Standard Bronze Off Exchange Plan","59.60%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%","$2,000","$4,000","70%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","2","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020011","Consumers Mutual Basic - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF003","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020011-01","Standard Bronze On Exchange Plan","59.60%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","60%","$2,000","$4,000","70%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","40047MI0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","40047MI0010001-03","Limited Cost Sharing Plan Variation","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-01","Standard Silver On Exchange Plan","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-03","Limited Cost Sharing Plan Variation","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-04","73% AV Level Silver Plan","73.90%","0.739199995994568","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$720","$180","$80","7"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-05","87% AV Level Silver Plan","88.00%","0.879453003406525","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$600","$320","$80","8"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","2","40047","MI","Individual","No","38-3341599","40047MI0010002","Molina Marketplace Silver Plan","40047MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.99435",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/silver","40047MI0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","40047MI0010003-01","Standard Bronze On Exchange Plan","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","4"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010009","Total Value Complete","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010009.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010009-01","Standard Silver On Exchange Plan","71.80%","0.694453716278076","No","No","No","100%",,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,800","$3,600","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010010","Total Saver Plus","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010010.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010010-00","Standard Bronze Off Exchange Plan","62.00%","0.617397129535675","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010013","Consumers Mutual Basic - High Deductible","41895MI001",,"MIN001","MIS050","MIF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans",,"http://www.consumersmutual.org/medication-formulary","41895MI0010013-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%","$6,000","$12,000","30%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010013","Consumers Mutual Basic - High Deductible","41895MI001",,"MIN001","MIS050","MIF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans",,"http://www.consumersmutual.org/medication-formulary","41895MI0010013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"23"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010013","Consumers Mutual Basic - High Deductible","41895MI001",,"MIN001","MIS050","MIF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans",,"http://www.consumersmutual.org/medication-formulary","41895MI0010013-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%","$6,000","$12,000","30%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","2","46275","MI","Individual","No","27-3991410","46275MI0010001","Humana Connect Basic 6350/6350 Plan","46275MI001",,"MIN001","MIS001","MIF001","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104622","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059083","http://apps.humana.com/marketing/documents.asp?file=2067338","46275MI0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","2","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Connect Bronze 6300/6300 Plan","46275MI001",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104648","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059096","http://apps.humana.com/marketing/documents.asp?file=2067338","46275MI0010002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","38791","SERFF","3","2013-08-23 12:24:02","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0030002","EHB High Passive","38791MI003",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.84",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"38791MI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","Personal Alliance 1500","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-1500ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390001-03","Limited Cost Sharing Plan Variation",,"0.789939880371094","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$3,000","0%",,,,"$5,000","$10,000","$6,500","$13,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400003","500","67577MI040","7760485905","MIN001","MIS001","MIF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-500ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400003-01","Standard Platinum On Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","0%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-04","73% AV Level Silver Plan",,"0.736137211322784","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-05","87% AV Level Silver Plan",,"0.866551399230957","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","$4,500","$9,000","$500","$1,000","0%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-06","94% AV Level Silver Plan",,"0.930617272853851","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$1,500","$3,000","$2,250","$4,500","$100","$200","0%",,,,"$200","$400","$300","$600","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400009","1500 (HSA)","67577MI040","7760485905","MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-1500ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400009-00","Standard Gold Off Exchange Plan",,"0.796283841133118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"4"
"2014","MI","41183","SERFF","5","2013-08-26 12:29:34","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0040002","EHB High PPO","41183MI004",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.40",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"41183MI0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","41183","SERFF","5","2013-08-26 12:29:34","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0040001","EHB Low PPO","41183MI004",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.48",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"41183MI0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","41183","SERFF","5","2013-08-26 12:29:34","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0030002","EHB High Passive","41183MI003",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.56",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"41183MI0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","38791","SERFF","3","2013-08-23 12:24:02","1","38791","MI","SHOP (Small Group)","Yes","47-0098400","38791MI0030001","EHB Low Passive","38791MI003",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.56",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"38791MI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","1","40047","MI","Individual","No","38-3341599","40047MI0010001","Molina Marketplace Gold Plan","40047MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/gold","40047MI0010001-01","Standard Gold On Exchange Plan","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","40047MI0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","MI","40047","SERFF","3","2013-10-16 19:58:29","3","40047","MI","Individual","No","38-3341599","40047MI0010003","Molina Marketplace Bronze Plan","40047MI001",,"MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All other than OB",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/mi/en-us/hp/marketplace/plans/bronze","40047MI0010003-03","Limited Cost Sharing Plan Variation","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060007","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS007",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060007-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-01","Standard Silver On Exchange Plan",,"0.685079514980316","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400005","1000","67577MI040","7760485905","MIN001","MIS001","MIF003","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-1000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400005-01","Standard Gold On Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$1,000","$2,000","0%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010010","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS010",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010010-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","Personal Alliance 1500","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-1500ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390001-01","Standard Gold On Exchange Plan",,"0.789939880371094","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","$13,500","$27,000","$1,500","$3,000","0%",,,,"$5,000","$10,000","$6,500","$13,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390001","Personal Alliance 1500","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-1500ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400003","500","67577MI040","7760485905","MIN001","MIS001","MIF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-500ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400003-00","Standard Platinum Off Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$500","$1,000","0%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","41183","SERFF","5","2013-08-26 12:29:34","1","41183","MI","SHOP (Small Group)","Yes","93-0242990","41183MI0030001","EHB Low Passive","41183MI003",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.04",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"41183MI0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010001","Consumers Mutual Premier - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010001-01","Standard Gold On Exchange Plan","78.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%","$1,000","$2,000","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020001","Consumers Mutual Premier - Low Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020001-00","Standard Gold Off Exchange Plan","78.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%","$1,000","$2,000","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010001","Consumers Mutual Premier - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020001","Consumers Mutual Premier - Low Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020001-01","Standard Gold On Exchange Plan","78.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%","$1,000","$2,000","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020002","Consumers Mutual Premier - No Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010001","Consumers Mutual Premier - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010001-03","Limited Cost Sharing Plan Variation","78.20%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%","$1,000","$2,000","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020002","Consumers Mutual Premier - No Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010002","Consumers Mutual Premier - No Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010001","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010002","Consumers Mutual Premier - No Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010001","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020003","Consumers Mutual Choice - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020003-00","Standard Silver Off Exchange Plan","68.40%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010002","Consumers Mutual Premier - No Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010001","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010002-03","Limited Cost Sharing Plan Variation","78.10%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020003","Consumers Mutual Choice - Medium Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020003-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020004","Consumers Mutual Choice - Low Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020004-00","Standard Silver Off Exchange Plan","68.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-01","Standard Silver On Exchange Plan","68.40%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020004","Consumers Mutual Choice - Low Deductible","41895MI002",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020004-01","Standard Silver On Exchange Plan","68.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020012","Consumers Mutual Basic - High Deductible","41895MI002",,"MIN001","MIS050","MIF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020012-00","Standard Bronze Off Exchange Plan","59.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%","$6,000","$12,000","30%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-03","Limited Cost Sharing Plan Variation","68.40%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","SHOP (Small Group)","No","45-3758112","41895MI0020012","Consumers Mutual Basic - High Deductible","41895MI002",,"MIN001","MIS050","MIF004","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage offered at the Alternate Benefit Level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0020012-01","Standard Bronze On Exchange Plan","59.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%","$6,000","$12,000","30%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-04","73% AV Level Silver Plan","73.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-05","87% AV Level Silver Plan","87.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010003","Consumers Mutual Choice - Medium Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010003-06","94% AV Level Silver Plan","94.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-01","Standard Silver On Exchange Plan","68.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"17"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-03","Limited Cost Sharing Plan Variation","68.30%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-04","73% AV Level Silver Plan","73.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%","$1,000","$2,000","30%","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","MI","41895","SERFF","10","2014-01-22 11:51:12","1","41895","MI","Individual","No","45-3758112","41895MI0010004","Consumers Mutual Choice - Low Deductible","41895MI001",,"MIN001","MIS050","MIF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","41895MI0010003","No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Coverage available at the Alternate Benefit level","Yes","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/members/individual-and-family-insurance-plans","http://www.consumersmutual.org/individual-and-family-insurance-plans","http://www.consumersmutual.org/medication-formulary","41895MI0010004-05","87% AV Level Silver Plan","87.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,000","$4,000","$2,000","$4,000","$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%","$0","$0","20%","$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010003","Humana Connect Silver 4600/6300 Plan","46275MI001",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104661","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059122","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Connect Gold 2500/3500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104674","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059148","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060008","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS008",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060008-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060009","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS009",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020009","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS009",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060006","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS006",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020006","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS006",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020007","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS007",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020007-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Connect Gold 2500/3500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104674","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059148","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010004","Humana Connect Gold 2500/3500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104674","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059148","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","1","46275","MI","Individual","No","27-3991410","46275MI0010005","Humana Connect Platinum 1000/1500 Plan","46275MI001",,"MIN001","MIS001","MIF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104687","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059174","http://apps.humana.com/marketing/documents.asp?file=2067403","46275MI0010005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","2","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Connect Bronze 6300/6300 Plan","46275MI001",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104648","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059096","http://apps.humana.com/marketing/documents.asp?file=2067338","46275MI0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MI","46275","SERFF","4","2013-09-16 08:58:26","2","46275","MI","Individual","No","27-3991410","46275MI0010002","Humana Connect Bronze 6300/6300 Plan","46275MI001",,"MIN001","MIS001","MIF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99949",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104648","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059096","http://apps.humana.com/marketing/documents.asp?file=2067338","46275MI0010002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","1","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010005-01","Standard Gold On Exchange Plan","78.20%","0.784045696258545","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","1","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","1","58594","MI","Individual","No","38-3253977","58594MI0010005","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010005-03","Limited Cost Sharing Plan Variation","78.20%","0.784045696258545","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-01","Standard Silver On Exchange Plan","68.17%","0.712508201599121","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","Not Applicable","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-03","Limited Cost Sharing Plan Variation","68.17%","0.712508201599121","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","Not Applicable","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-04","73% AV Level Silver Plan","72.30%","0.742933809757233","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-05","87% AV Level Silver Plan","86.10%","0.872259676456451","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","2","58594","MI","Individual","No","38-3253977","58594MI0010004","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010004-06","94% AV Level Silver Plan","93.20%","0.93553900718689","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","Not Applicable","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010002-01","Standard Bronze On Exchange Plan","58.90%","0.639417469501495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010002","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010002-03","Limited Cost Sharing Plan Variation","58.90%","0.639417469501495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010003","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010003-01","Standard Bronze On Exchange Plan","58.90%","0.580280721187592","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010003","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","3","58594","MI","Individual","No","38-3253977","58594MI0010003","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010003-03","Limited Cost Sharing Plan Variation","58.90%","0.580280721187592","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,700","Not Applicable","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","58594","SERFF","3","2014-01-22 11:51:12","4","58594","MI","Individual","No","38-3253977","58594MI0010001","Meridian Choice: Your Connection to Bronson Healthcare","58594MI001","7992708124","MIN001","MIS001","MIF005","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All Specialists",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Emergent","Yes","www.mhplan.com/meridianchoice/sbc","www.mhplan.com/meridianchoice/member",,"www.mhplan.com/meridianchoice/formulary","58594MI0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","Not Applicable","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MI","62294","SERFF","4","2014-01-22 11:51:12","1","62294","MI","Individual","Yes","39-1263473","62294MI0420001","Humana Dental Smart Choice","62294MI042",,"MIN001","MIS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.34",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084316",,"62294MI0420001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0010001","Guardian Pediatric Advantage","66587MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0010001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0010001","Guardian Pediatric Advantage","66587MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0010001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0020001","Guardian Pediatric Essentials","66587MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0020001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","1","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0020001","Guardian Pediatric Essentials","66587MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0020001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0030001","Guardian Family Advantage Plus","66587MI003",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0030001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","2","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0030001","Guardian Family Advantage Plus","66587MI003",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0030001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","3","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0050001","Guardian Family Essentials Plus","66587MI005",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0050001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","3","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0050001","Guardian Family Essentials Plus","66587MI005",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0050001-01","Standard Low On Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"$700","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","4","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0040001","Guardian Family Advantage","66587MI004",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0040001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","4","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0040001","Guardian Family Advantage","66587MI004",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.73",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0040001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","4","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0060001","Guardian Family Essentials","66587MI006",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0060001-00","Standard Low Off Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","66587","SERFF","3","2013-09-11 14:31:09","4","66587","MI","SHOP (Small Group)","Yes","13-5123390","66587MI0060001","Guardian Family Essentials","66587MI006",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"66587MI0060001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030001-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030001-00","Standard Gold Off Exchange Plan","81.00%","0.808100640773773","No","No","No","100%",,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,"$2,130","4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010001","Total Platinum Premier","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010001.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010001-00","Standard Platinum Off Exchange Plan","89.80%","0.897522151470184","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010001","Total Platinum Premier","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010001.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010001-01","Standard Platinum On Exchange Plan","89.80%","0.897522151470184","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030001-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030001-01","Standard Gold On Exchange Plan","81.00%","0.808100640773773","No","No","No","100%",,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,"$2,130","5"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030001-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010002","Total Platinum Ultimate","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010002.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010002-00","Standard Platinum Off Exchange Plan","90.40%","0.913333833217621","No","No","No","100%",,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030001","Total HMO Standard","67183MI003",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030001-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030001-03","Limited Cost Sharing Plan Variation","81.00%","0.808100640773773","No","No","No","100%",,"$1,750","$3,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010002","Total Platinum Ultimate","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010002.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010002-01","Standard Platinum On Exchange Plan","90.40%","0.913333833217621","No","No","No","100%",,"$1,200","$2,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-00","Standard Silver Off Exchange Plan","71.10%","0.710693597793579","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010003","Total Platinum Signature","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010003.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010003-00","Standard Platinum Off Exchange Plan","90.80%","0.909112989902496","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010003","Total Platinum Signature","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010003.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010003-01","Standard Platinum On Exchange Plan","90.80%","0.909112989902496","No","No","No","100%",,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-01","Standard Silver On Exchange Plan","71.10%","0.710693597793579","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010004","Total Platinum Complete","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010004.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010004-00","Standard Platinum Off Exchange Plan","91.40%","0.914255023002625","No","No","No","100%",,"$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010004","Total Platinum Complete","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Platinum","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010004.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010004-01","Standard Platinum On Exchange Plan","91.40%","0.914255023002625","No","No","No","100%",,"$950","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-03","Limited Cost Sharing Plan Variation","71.10%","0.710693597793579","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010005","Total Gold Premier","67183MI001",,"MIN001","MIS001","MIF001","New","HMO","Gold","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010005.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010005-00","Standard Gold Off Exchange Plan","81.80%","0.817814826965332","No","No","No","100%",,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$0","$0","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","1","67183","MI","Individual","No","38-3240485","67183MI0030002","Totally You","67183MI003",,"MIN001","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","Podiatry, Chiropractic",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/individuals/67183MI0030002-01.pdf","https://thcmi.softheon.com/Marketplace/PaymentCenter/Payment.aspx","http://brochure.thcmi.com/","http://formularies.thcmi.com/individual.pdf","67183MI0030002-04","73% AV Level Silver Plan","73.80%","0.73876965045929","No","No","No","100%",,"$4,200","$8,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010010","Total Saver Plus","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010010.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010010-01","Standard Bronze On Exchange Plan","62.00%","0.617397129535675","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010011","Total Saver Complete","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010011.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010011-00","Standard Bronze Off Exchange Plan","60.60%","0.606177449226379","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","67183","SERFF","5","2014-03-14 10:14:14","3","67183","MI","SHOP (Small Group)","No","38-3240485","67183MI0010011","Total Saver Complete","67183MI001",,"MIN001","MIS001","MIF004","New","HMO","Bronze","Yes","Both","No","Yes","Podiatry, Chiropractic",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency","Yes","Emergency","No","http://sbc.thcmi.com/shop/67183MI0010011.pdf","http://enrollment.thcmi.com/shop","http://brochure.thcmi.com/","http://formularies.thcmi.com/shop.pdf","67183MI0010011-01","Standard Bronze On Exchange Plan","60.60%","0.606177449226379","No","No","No","100%",,"$5,350","$10,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060003","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS003",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060003-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020003","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS003",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020003-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060004","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS004",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060004-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400007","2000","67577MI040","7760485905","MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-2000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400007-00","Standard Silver Off Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","Individual","No","38-3291563","67577MI0390004","Personal Alliance 3000","67577MI039","7760485905","MIN001","MIS001","MIF006","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461661",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390004-03","Limited Cost Sharing Plan Variation",,"0.685079514980316","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$3,000","$6,000","20%",,,,"$6,000","$12,000","$9,000","$18,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","1","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400007","2000","67577MI040","7760485905","MIN001","MIS001","MIF005","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-2000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400007-01","Standard Silver On Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","Personal Alliance 5000 (HSA)","67577MI039","7760485905","MIN001","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-5000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390006-00","Standard Bronze Off Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"4"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","Personal Alliance 5000 (HSA)","67577MI039","7760485905","MIN001","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-5000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390006-01","Standard Bronze On Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410005","2000","67577MI041","7760485905","MIN001","MIS001","MIF005","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410005-01","Standard Silver On Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000","$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MI","74709","SERFF","2","2013-08-05 08:16:03","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010001","DentalConnect�","74709MI001",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.91",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"74709MI0010001-00","Standard High Off Exchange Plan","84.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","74709","SERFF","2","2013-08-05 08:16:03","1","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010002","DentalConnect�","74709MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.61",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"74709MI0010002-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","74709","SERFF","2","2013-08-05 08:16:03","2","74709","MI","SHOP (Small Group)","Yes","35-0472300","74709MI0010003","DentalConnect�","74709MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"74709MI0010003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","75936","SERFF","1","2013-08-01 21:15:43","1","75936","MI","SHOP (Small Group)","Yes","47-0397286","75936MI0030001","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.98",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"75936MI0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","75936","SERFF","1","2013-08-01 21:15:43","1","75936","MI","SHOP (Small Group)","Yes","47-0397286","75936MI0030002","Renaissance Group Dental PPO, EHB Certified","75936MI003",,"MIN001","MIS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.53",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"75936MI0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050002","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS002",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050002-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010002","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS002",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010002-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050003","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS003",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050003-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010003","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS003",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010003-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010004","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS004",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050004","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS004",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050005","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS005",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050005-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010005","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS005",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010005-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050006","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS006",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050006-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010006","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS006",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010006-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110008","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS008",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110008-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030008","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS008",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030008-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030009","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS009",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030009-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110009","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS009",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110009-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030010","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS010",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030010-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110010","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS010",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400009","1500 (HSA)","67577MI040","7760485905","MIN001","MIS001","MIF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-1500ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400009-01","Standard Gold On Exchange Plan",,"0.796283841133118","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000",,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","Personal Alliance 5000 (HSA)","67577MI039","7760485905","MIN001","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-5000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400011","2000 (HSA)","67577MI040","7760485905","MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-2000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400011-00","Standard Silver Off Exchange Plan",,"0.696801781654358","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"7"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","Individual","No","38-3291563","67577MI0390006","Personal Alliance 5000 (HSA)","67577MI039","7760485905","MIN001","MIS001","MIF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461665",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-5000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390006-03","Limited Cost Sharing Plan Variation",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"7"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","2","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400011","2000 (HSA)","67577MI040","7760485905","MIN001","MIS001","MIF001","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-2000ppohsa.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400011-01","Standard Silver On Exchange Plan",,"0.696801781654358","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000",,,,,,,,,"8"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","3","67577","MI","Individual","No","38-3291563","67577MI0390008","Personal Alliance 6350","67577MI039","7760485905","MIN001","MIS001","MIF008","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461663",,,"0","3","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-6350ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390008-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","$16,350","$32,700",,,,,,,,,"4"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070008","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS008",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070008-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070009","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS009",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070009-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070010","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS010",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080002","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS002",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080003","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS003",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080004","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS004",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080004-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080005","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS005",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080005-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080006","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS006",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080007","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS007",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080008","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS008",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080008-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080009","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS009",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","6","86217","MI","Individual","Yes","38-2724203","86217MI0080010","Select Dental Healthy Family Value","86217MI008",,"MIN001","MIS010",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfvalue/summary","www.goldendentalplans.com/plans/select/oe/hfvalue/buy","www.goldendentalplans.com/plans/select/oe/hfvalue",,"86217MI0080010-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090002","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS002",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090003","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS003",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090003-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","3","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400013","3000","67577MI040","7760485905","MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","2","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400013-00","Standard Bronze Off Exchange Plan",,"0.616840779781342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,"4"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090007","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS007",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090007-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090008","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS008",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090008-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090009","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS009",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090009-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090010","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS010",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090010-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100002","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS002",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100003","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS003",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100004","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS004",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100004-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100005","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS005",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100005-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100006","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS006",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100007","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS007",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","3","67577","MI","Individual","No","38-3291563","67577MI0390008","Personal Alliance 6350","67577MI039","7760485905","MIN001","MIS001","MIF008","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986926636461663",,,"0","3","0","2014-01-01",,"Yes","Emergency Services and Out of Network Benefits Apply","Yes","Emergency Services and Out of Network Benefits Apply","Yes","www.hap.org/sbc/on-pa-6350ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/personalalliance/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0390008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$10,000","$20,000","$16,350","$32,700",,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","3","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0400013","3000","67577MI040","7760485905","MIN001","MIS001","MIF005","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","2","2014-01-01",,"Yes","Emergency Services and Out of Network benefits apply.","Yes","Emergency Services and Out of Network benefits apply.","Yes","www.hap.org/sbc/on-group-3000ppo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0400013-01","Standard Bronze On Exchange Plan",,"0.616840779781342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$6,000","$12,000","$9,000","$18,000",,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410001","500","67577MI041","7760485905","MIN001","MIS001","MIF002","New","EPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-500epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410001-00","Standard Platinum Off Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$0","$0","$1,000","$2,000","$500","$1,000","0%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410001","500","67577MI041","7760485905","MIN001","MIS001","MIF002","New","EPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-500epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410001-01","Standard Platinum On Exchange Plan",,"0.884894788265228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$0","$0","$1,000","$2,000","$500","$1,000","0%",,,,"$0","$0","$500","$1,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410003","1000","67577MI041","7760485905","MIN001","MIS001","MIF003","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1000epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410003-00","Standard Gold Off Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410003","1000","67577MI041","7760485905","MIN001","MIS001","MIF003","New","EPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436525",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-1000epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410003-01","Standard Gold On Exchange Plan",,"0.79557466506958","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000","$1,000","$2,000","0%",,,,"$0","$0","$1,000","$2,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MI","67577","SERFF","5","2013-11-27 09:24:34","4","67577","MI","SHOP (Small Group)","No","38-3291563","67577MI0410005","2000","67577MI041","7760485905","MIN001","MIS001","MIF005","New","EPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990135854436524",,,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Emergency Services Only","No","www.hap.org/sbc/on-group-2000epo.pdf","www.hap.org/healthinsurance/payment.php","www.hap.org/healthinsurance/group/pdf/sales.pdf","www.hap.org/prescriptions/docs/ehb_formulary.pdf","67577MI0410005-00","Standard Silver Off Exchange Plan",,"0.7088223695755","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000","$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050007","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS007",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050007-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010007","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS007",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010007-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010008","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS008",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010008-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050008","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS008",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050008-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","Individual","Yes","38-2724203","86217MI0010009","Select Dental Healthy Family Max","86217MI001",,"MIN001","MIS009",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfmax/summary","www.goldendentalplans.com/plans/select/hfmax/buy","www.goldendentalplans.com/plans/select/hfmax",,"86217MI0010009-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050009","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS009",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050009-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","1","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0050010","Select Dental Healthy Group Max","86217MI005",,"MIN001","MIS010",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgmax/summary","www.goldendentalplans.com/plans/select/hgmax/buy","www.goldendentalplans.com/plans/select/hgmax",,"86217MI0050010-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020004","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS004",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020004-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0060010","Select Dental Healthy Group Value","86217MI006",,"MIN001","MIS010",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hgvalue/summary","www.goldendentalplans.com/plans/select/hgvalue/buy","www.goldendentalplans.com/plans/select/hgvalue",,"86217MI0060010-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","2","86217","MI","Individual","Yes","38-2724203","86217MI0020010","Select Dental Healthy Family Value","86217MI002",,"MIN001","MIS010",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hfvalue/summary","www.goldendentalplans.com/plans/select/hfvalue/buy","www.goldendentalplans.com/plans/select/hfvalue",,"86217MI0020010-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110002","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS002",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030002","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS002",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030002-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110003","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS003",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110003-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030003","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS003",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030003-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110004","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS004",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030004","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS004",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030004-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030005","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS005",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030005-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110005","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS005",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110005-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030006","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS006",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030006-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110006","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS006",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110006-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0110007","Select Dental Healthy Group Max","86217MI011",,"MIN001","MIS007",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/eo/hgmax/summary","www.goldendentalplans.com/plans/select/oe/hgmax/buy","www.goldendentalplans.com/plans/select/oe/hgmax",,"86217MI0110007-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","3","86217","MI","Individual","Yes","38-2724203","86217MI0030007","Select Dental Healthy Kids Max","86217MI003",,"MIN001","MIS007",,"New","EPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkmax/summary","www.goldendentalplans.com/plans/select/hkmax/buy","www.goldendentalplans.com/plans/select/hkmax",,"86217MI0030007-01","Standard High On Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120002","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS002",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120002-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040002","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS002",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040002-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040003","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS003",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040003-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120003","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS003",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120003-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040004","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS004",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040004-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120004","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS004",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120004-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120005","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS005",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120005-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040005","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS005",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040005-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120006","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS006",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120006-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040006","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS006",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040006-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040007","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS007",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040007-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120007","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS007",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120007-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120008","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS008",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120008-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040008","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS008",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040008-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040009","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS009",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040009-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120009","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS009",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","SHOP (Small Group)","Yes","38-2724203","86217MI0120010","Select Dental Healthy Group Value","86217MI012",,"MIN001","MIS010",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hgvalue/summary","www.goldendentalplans.com/plans/select/oe/hgvalue/buy","www.goldendentalplans.com/plans/select/oe/hgvalue",,"86217MI0120010-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","4","86217","MI","Individual","Yes","38-2724203","86217MI0040010","Select Dental Healthy Kids Value","86217MI004",,"MIN001","MIS010",,"New","EPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/hkvalue/summary","www.goldendentalplans.com/plans/select/hkvalue/buy","www.goldendentalplans.com/plans/select/hkvalue",,"86217MI0040010-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070002","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS002",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070003","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS003",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070003-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070004","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS004",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070005","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS005",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070005-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070006","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS006",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070006-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","5","86217","MI","Individual","Yes","38-2724203","86217MI0070007","Select Dental Healthy Family Max","86217MI007",,"MIN001","MIS007",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hfmax/summary","www.goldendentalplans.com/plans/select/oe/hfmax/buy","www.goldendentalplans.com/plans/select/oe/hfmax",,"86217MI0070007-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090004","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS004",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090005","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS005",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090005-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","7","86217","MI","Individual","Yes","38-2724203","86217MI0090006","Select Dental Healthy Kids Max","86217MI009",,"MIN001","MIS006",,"New","EPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$45.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkmax/summary","www.goldendentalplans.com/plans/select/oe/hkmax/buy","www.goldendentalplans.com/plans/select/oe/hkmax",,"86217MI0090006-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100008","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS008",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100008-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100009","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS009",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100009-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","MI","86217","SERFF","3","2013-09-11 14:31:09","8","86217","MI","Individual","Yes","38-2724203","86217MI0100010","Select Dental Healthy Kids Value","86217MI010",,"MIN001","MIS010",,"New","EPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$36.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency only. $100 limit.","Yes","Emergency only. $100 limit.","No","www.goldendentalplans.com/plans/select/oe/hkvalue/summary","www.goldendentalplans.com/plans/select/oe/hkvalue/buy","www.goldendentalplans.com/plans/select/oe/hkvalue",,"86217MI0100010-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020001","Dentegra Dental PPO Children's Plan 70","94523MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.21",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020001",,"94523MI0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$40","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","Individual","Yes","75-1233841","94523MI0010001","Dentegra Dental PPO Children's Plan 70","94523MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010001",,"94523MI0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020001","Dentegra Dental PPO Children's Plan 70","94523MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.21",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020001",,"94523MI0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$40","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","Individual","Yes","75-1233841","94523MI0010001","Dentegra Dental PPO Children's Plan 70","94523MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010001",,"94523MI0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","Individual","Yes","75-1233841","94523MI0010002","Dentegra Dental PPO Children's Plan 85","94523MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010002",,"94523MI0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020002","Dentegra Dental PPO Children's Plan 85","94523MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020002",,"94523MI0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","Individual","Yes","75-1233841","94523MI0010002","Dentegra Dental PPO Children's Plan 85","94523MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010002",,"94523MI0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","1","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020002","Dentegra Dental PPO Children's Plan 85","94523MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020002",,"94523MI0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","2","94523","MI","Individual","Yes","75-1233841","94523MI0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","94523MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010006",,"94523MI0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","2","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","94523MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020006",,"94523MI0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","2","94523","MI","Individual","Yes","75-1233841","94523MI0010006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults","94523MI001",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.02",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010006",,"94523MI0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","2","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020006","Dentegra Dental PPO Children's Plan 70 + Basic for Adults for Small Businesses","94523MI002",,"MIN001","MIS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.21",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020006",,"94523MI0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"$60","Not Applicable","$60","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","3","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","94523MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020004",,"94523MI0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","3","94523","MI","Individual","Yes","75-1233841","94523MI0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","94523MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010004",,"94523MI0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","3","94523","MI","Individual","Yes","75-1233841","94523MI0010004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults","94523MI001",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.74",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/mi/94523mi0010004",,"94523MI0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","94523","SERFF","9","2014-01-22 11:51:12","3","94523","MI","SHOP (Small Group)","Yes","75-1233841","94523MI0020004","Dentegra Dental PPO Children's Plan 85 + Preferred for Adults for Small Businesses","94523MI002",,"MIN001","MIS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.98",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/mi/94523mi0020004",,"94523MI0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$60","Not Applicable",,,,,"$60","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180001","Blue Cross � Select Value","98185MI018",,"MIN001","MIS004","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","4"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180001","Blue Cross � Select Value","98185MI018",,"MIN001","MIS004","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","5"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180002","Blue Cross � Preferred Value","98185MI018",,"MIN002","MIS003","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180002-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","6"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180002","Blue Cross � Preferred Value","98185MI018",,"MIN002","MIS003","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","7"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180003","Blue Cross � Partnered Value","98185MI018",,"MIN003","MIS005","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","8"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180003","Blue Cross � Partnered Value","98185MI018",,"MIN003","MIS005","MIF051","New","HMO","Catastrophic","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,570","$0","$0","$150","$4,410","$180","$0","$80","9"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130007","BCN Gold $1500","98185MI013","7457354687","MIN002","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130007","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130007-00","Standard Gold Off Exchange Plan","79.10%","0.794309556484222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$10","$1,150","$150","$1,150","$160","$250","$80","10"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-00","Standard Silver Off Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","10"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-01","Standard Silver On Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","11"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130007","BCN Gold $1500","98185MI013","7457354687","MIN002","MIS001","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130007","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130007-01","Standard Gold On Exchange Plan","79.10%","0.794309556484222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$10","$1,150","$150","$1,150","$160","$250","$80","11"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","12"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-03","Limited Cost Sharing Plan Variation","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","13"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130009","BCN PCP Focus Gold $1500","98185MI013","7457354687","MIN001","MIS002","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130009","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130009-00","Standard Gold Off Exchange Plan","79.10%","0.794309556484222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$10","$1,150","$150","$1,150","$160","$250","$80","13"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130009","BCN PCP Focus Gold $1500","98185MI013","7457354687","MIN001","MIS002","MIF002","New","HMO","Gold","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-gold-130009","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130009-01","Standard Gold On Exchange Plan","79.10%","0.794309556484222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,500","$10","$1,150","$150","$1,150","$160","$250","$80","14"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-04","73% AV Level Silver Plan","72.10%","0.730829298496246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,450","$510","$1,080","$150","$1,450","$290","$310","$80","14"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-05","87% AV Level Silver Plan","86.00%","0.854117870330811","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$450","$900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$510","$460","$150","$450","$340","$130","$80","15"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180004","Blue Cross � Select Silver","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180004-06","94% AV Level Silver Plan","93.30%","0.930530428886414","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$175","$0","$320","$150","$175","$190","$120","$80","16"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-00","Standard Silver Off Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","17"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-01","Standard Silver On Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","18"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","19"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-03","Limited Cost Sharing Plan Variation","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","20"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130015","BCN Silver $3000","98185MI013","7457354687","MIN002","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130015","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130015-00","Standard Silver Off Exchange Plan","69.90%","0.699357390403748","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$10","$850","$150","$1,150","$240","$250","$80","20"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130015","BCN Silver $3000","98185MI013","7457354687","MIN002","MIS001","MIF002","New","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130015","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130015-01","Standard Silver On Exchange Plan","69.90%","0.699357390403748","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$10","$850","$150","$1,150","$240","$250","$80","21"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-04","73% AV Level Silver Plan","72.10%","0.730829298496246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,450","$510","$1,080","$150","$1,450","$290","$310","$80","21"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-05","87% AV Level Silver Plan","86.00%","0.854117870330811","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$450","$900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$510","$460","$150","$450","$340","$130","$80","22"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130017","BCN PCP Focus Silver $3000","98185MI013","7457354687","MIN001","MIS002","MIF002","New","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130017","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130017-00","Standard Silver Off Exchange Plan","69.90%","0.699357390403748","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$10","$850","$150","$1,150","$240","$250","$80","23"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180005","Blue Cross � Preferred Silver","98185MI018",,"MIN002","MIS001","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180005-06","94% AV Level Silver Plan","93.30%","0.930530428886414","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$175","$0","$320","$150","$175","$190","$120","$80","23"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-00","Standard Silver Off Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","24"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0130017","BCN PCP Focus Silver $3000","98185MI013","7457354687","MIN001","MIS002","MIF002","New","HMO","Silver","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hmo-silver-130017","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0130017-01","Standard Silver On Exchange Plan","69.90%","0.699357390403748","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$10","$850","$150","$1,150","$240","$250","$80","24"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-01","Standard Silver On Exchange Plan","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","25"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","26"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-03","Limited Cost Sharing Plan Variation","68.20%","0.694614827632904","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,650","$3,300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,650","$510","$1,020","$150","$1,650","$290","$270","$80","27"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-04","73% AV Level Silver Plan","72.10%","0.730829298496246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,450","$510","$1,080","$150","$1,450","$290","$310","$80","28"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-05","87% AV Level Silver Plan","86.00%","0.854117870330811","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$450","$900","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$450","$510","$460","$150","$450","$340","$130","$80","29"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180007","Blue Cross � Partnered Silver","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Silver","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180007-06","94% AV Level Silver Plan","93.30%","0.930530428886414","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$175","$0","$320","$150","$175","$190","$120","$80","30"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross � Select Gold","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180008-00","Standard Gold Off Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","31"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross � Select Gold","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180008-01","Standard Gold On Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","32"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross � Select Gold","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","33"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180008","Blue Cross � Select Gold","98185MI018",,"MIN001","MIS004","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180008-03","Limited Cost Sharing Plan Variation","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","34"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross � Preferred Gold","98185MI018",,"MIN002","MIS003","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180009-00","Standard Gold Off Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","35"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross � Preferred Gold","98185MI018",,"MIN002","MIS003","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180009-01","Standard Gold On Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","36"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross � Preferred Gold","98185MI018",,"MIN002","MIS003","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","37"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180009","Blue Cross � Preferred Gold","98185MI018",,"MIN002","MIS003","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180009-03","Limited Cost Sharing Plan Variation","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","38"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross � Partnered Gold","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180010-00","Standard Gold Off Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","39"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross � Partnered Gold","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180010-01","Standard Gold On Exchange Plan","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","40"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross � Partnered Gold","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","41"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","1","98185","MI","Individual","No","38-2359234","98185MI0180010","Blue Cross � Partnered Gold","98185MI018",,"MIN003","MIS005","MIF052","New","HMO","Gold","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0180010-03","Limited Cost Sharing Plan Variation","78.10%","0.80040717124939","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,100","$10,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$510","$960","$150","$250","$340","$270","$80","42"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross � Select Bronze","98185MI044",,"MIN001","MIS004","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440001-00","Standard Bronze Off Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","4"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross � Select Bronze","98185MI044",,"MIN001","MIS004","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440001-01","Standard Bronze On Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","5"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross � Select Bronze","98185MI044",,"MIN001","MIS004","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440001","Blue Cross � Select Bronze","98185MI044",,"MIN001","MIS004","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440001-03","Limited Cost Sharing Plan Variation","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","7"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross � Preferred Bronze","98185MI044",,"MIN002","MIS001","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440002-00","Standard Bronze Off Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","8"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross � Preferred Bronze","98185MI044",,"MIN002","MIS001","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440002-01","Standard Bronze On Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","9"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross � Preferred Bronze","98185MI044",,"MIN002","MIS001","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440002","Blue Cross � Preferred Bronze","98185MI044",,"MIN002","MIS001","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440002-03","Limited Cost Sharing Plan Variation","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","11"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross � Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440004-00","Standard Bronze Off Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","12"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross � Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440004-01","Standard Bronze On Exchange Plan","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","13"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross � Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","2","98185","MI","Individual","No","38-2359234","98185MI0440004","Blue Cross � Partnered Bronze","98185MI044",,"MIN003","MIS005","MIF052","New","HMO","Bronze","Yes","Both","No","Yes","All except routine ob/gyn & pediatric visits",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","1","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","No","www.bcbsm.com/sbc","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/plan-details","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0440004-03","Limited Cost Sharing Plan Variation","58.20%","0.600909113883972","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,950","$11,900","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,950","$140","$0","$150","$5,260","$0","$0","$40","15"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","4","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160009","BCN HSA PCP Focus Bronze $4000 ($0)","98185MI016","7457354687","MIN001","MIS002","MIF002","New","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160009","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0160009-00","Standard Bronze Off Exchange Plan","60.30%","0.602807521820068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10","$650","$150","$4,000","$80","$180","$80","12"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","4","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160009","BCN HSA PCP Focus Bronze $4000 ($0)","98185MI016","7457354687","MIN001","MIS002","MIF002","New","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160009","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0160009-01","Standard Bronze On Exchange Plan","60.30%","0.602807521820068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10","$650","$150","$4,000","$80","$180","$80","13"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","4","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160013","BCN HSA PCP Focus Bronze $3000 ($0)","98185MI016","7457354687","MIN001","MIS002","MIF002","New","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160013","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0160013-00","Standard Bronze Off Exchange Plan","61.90%","0.618193387985229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$10","$1,280","$150","$3,000","$120","$400","$80","17"
"2014","MI","98185","SERFF","8","2014-01-22 11:51:12","4","98185","MI","SHOP (Small Group)","No","38-2359234","98185MI0160013","BCN HSA PCP Focus Bronze $3000 ($0)","98185MI016","7457354687","MIN001","MIS002","MIF002","New","HMO","Bronze","Yes","Both","No","Yes","All except for routine OB/GYN and pediatric visits","Out-of-network services",,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$300","0","0","0","2014-01-01","2015-12-31","Yes","Emergent Care only","Yes","Emergency and urgent care only","No","http://www.bcbsm.com/employer/sbc/bcn-hsa-bronze-160013","http://www.bcbsm.com/index/health-insurance-help/faqs/topics/managing-my-account/payments-faq/individual-bcn-plan-pay-bill.html","http://www.bcbsm.com/employer-hmo-plan-brochures","http://www.bcbsm.com/custom-select-formulary-drug-list-hmo","98185MI0160013-01","Standard Bronze On Exchange Plan","61.90%","0.618193387985229","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$10","$1,280","$150","$3,000","$120","$400","$80","18"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-01","Standard Silver On Exchange Plan",,"0.703477382659912","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,300","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220002","Kids Dental Choice 0/20/50/50","23603MT022",,"MTN003","MTS002",,"New","Indemnity","High",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Child-Only",,,,"$33.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0220002-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","Yes","81-0216685","30751MT0580001","BlueCare Dental 1A","30751MT058",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$52.59",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580001-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560005","Blue Preferred Gold PPO 005","30751MT056",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560005-00","Standard Gold Off Exchange Plan","79.04%","0.790639460086823","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-04","73% AV Level Silver Plan",,"0.724087059497833","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,450","$2,900","40%",,,,"$2,900","$5,800","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-05","87% AV Level Silver Plan",,"0.868871569633484","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,950","$3,900",,,"$3,900","$7,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-06","94% AV Level Silver Plan",,"0.937275648117065","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050004","Connected Care_Bronze","32225MT005",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-BRZ/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050004-00","Standard Bronze Off Exchange Plan",,"0.612320065498352","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care_Bronze","32225MT001",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010003-00","Standard Bronze Off Exchange Plan",,"0.58912068605423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care_Bronze","32225MT001",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010003-01","Standard Bronze On Exchange Plan",,"0.58912068605423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050004","Connected Care_Bronze","32225MT005",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-BRZ/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050004-01","Standard Bronze On Exchange Plan",,"0.612320065498352","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care_Bronze","32225MT001",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-01","Standard Silver On Exchange Plan","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","Individual","No","93-0245545","23603MT0140002","SmartHealth Catastrophic","23603MT014",,"MTN001","MTS001","MTF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967569&libID=4294967569","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0140002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$0","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200001","Dental Choice 0/20/50/50 50/750","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"On the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200001-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$0","$0","$3,000","$0","$0","$40","19"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$0","$0","$3,000","$0","$0","$40","20"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180012","SmartHealth Balance Silver 1500","23603MT018",,"MTN001","MTS001","MTF014","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967594&libID=4294967594","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0180012-01","Standard Silver On Exchange Plan",,"0.717990636825562","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,100","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220001","Kids Dental Choice 20/40/50/50","23603MT022",,"MTN003","MTS002",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Child-Only",,,,"$27.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0220001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","8","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210005","Dental Choice Plus 0/20/20/50 25/2000","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","8","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210006","Dental Choice Plus 0/20/20/50 50/2000","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-06","94% AV Level Silver Plan",,"0.9306640625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$800","$1,600",,,"$1,600","$3,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","8","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care_Bronze","32225MT002",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020004-00","Standard Bronze Off Exchange Plan",,"0.612320065498352","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","8","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care_Bronze","32225MT002",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020004-01","Standard Bronze On Exchange Plan",,"0.612320065498352","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170007","SmartHealth Value Bronze 3000","23603MT017",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967596&libID=4294967596","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0170007-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,200","$0","$3,000","$0","$1,100","$40","4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-03","Limited Cost Sharing Plan Variation","70.11%","0.701061606407166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","3","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0050001","Guardian Family Essentials Plus","62818MT005",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","3","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0050001","Guardian Family Essentials Plus","62818MT005",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0050001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","4","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0040001","Guardian Family Advantage","62818MT004",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0040001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200005","Dental Choice 0/20/20/50 25/1500","23603MT020",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180010","SmartHealth Balance Bronze 3500","23603MT018",,"MTN001","MTS001","MTF004","New","PPO","Bronze","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","5","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967592&libID=4294967592","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0180010-01","Standard Bronze On Exchange Plan",,"0.61512017250061","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,500","$0","$1,900","$0","$3,500","$300","$600","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF017","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967566&libID=4294967566","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0","$0","$0","$0","$200","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200006","Dental Choice 0/20/20/50 50/1500","23603MT020",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550005","Blue Preferred Bronze PPO 005","30751MT055",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes",,,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-01","Standard Bronze On Exchange Plan",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","Yes","81-0216685","30751MT0580003","BlueCare Dental 4 Kids 1A","30751MT058",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$52.59",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580003-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560018","Blue Preferred Bronze PPO 018","30751MT056",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560018-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590003","BlueCare Dental 4 Kids 1A","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590003-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560018","Blue Preferred Bronze PPO 018","30751MT056",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560018-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3000","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967570&libID=4294967570","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150006-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,200","$0","$3,000","$0","$1,100","$40","9"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3000","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967570&libID=4294967570","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","10"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF017","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967566&libID=4294967566","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160007-03","Limited Cost Sharing Plan Variation",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6350","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967565&libID=4294967565","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160004-00","Standard Bronze Off Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6350","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967565&libID=4294967565","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6350","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967565&libID=4294967565","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160004-03","Limited Cost Sharing Plan Variation",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-00","Standard Silver Off Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560020","Blue Preferred Silver PPO 020","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560020-01","Standard Silver On Exchange Plan","71.60%","0.71602863073349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-03","Limited Cost Sharing Plan Variation","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210001","Dental Choice Plus 0/20/20/50 25/1000","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","Yes","81-0216685","30751MT0580003","BlueCare Dental 4 Kids 1A","30751MT058",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$52.59",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580003-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes",,,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590004","BlueCare Dental 4 Kids 1B","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590004-00","Standard Low Off Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","Yes","81-0216685","30751MT0580004","BlueCare Dental 4 Kids 1B","30751MT058",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$43.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580004-00","Standard Low Off Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550005","Blue Preferred Bronze PPO 005","30751MT055",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$0","$0","$0","$500","$0","$0","$40","25"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180011","SmartHealth Balance Silver 2000","23603MT018",,"MTN001","MTS001","MTF013","New","PPO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967595&libID=4294967595","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0180011-01","Standard Silver On Exchange Plan",,"0.707728743553162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$1,400","$2,100","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-00","Standard Silver Off Exchange Plan",,"0.703477382659912","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,300","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0220001","Kids Dental Choice 20/40/50/50","23603MT022",,"MTN003","MTS002",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Child-Only",,,,"$27.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0220001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0570005","Blue Cross Blue Shield Basic 5, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes",,,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570005-03","Limited Cost Sharing Plan Variation",,"0.611617028713226","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560019","Blue Preferred Bronze PPO 019","30751MT056",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560019-00","Standard Bronze Off Exchange Plan",,"0.581020891666412","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560019","Blue Preferred Bronze PPO 019","30751MT056",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560019-01","Standard Bronze On Exchange Plan",,"0.581020891666412","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550005","Blue Preferred Bronze PPO 005","30751MT055",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-03","Limited Cost Sharing Plan Variation",,"0.690834283828735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-04","73% AV Level Silver Plan",,"0.737469434738159","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-05","87% AV Level Silver Plan",,"0.866200804710388","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"$500","$1,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","Individual","Yes","93-0245545","23603MT0190001","Kids Dental Choice 20/40/50/50","23603MT019",,"MTN003","MTS002",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Child-Only",,,,"$28.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/",,"23603MT0190001-00","Standard Low Off Exchange Plan","68.20%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","Individual","Yes","93-0245545","23603MT0190001","Kids Dental Choice 20/40/50/50","23603MT019",,"MTN003","MTS002",,"New","Indemnity","Low",,"Both",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Child-Only",,,,"$28.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/",,"23603MT0190001-01","Standard Low On Exchange Plan","68.20%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170008","SmartHealth Value Silver 3000","23603MT017",,"MTN001","MTS001","MTF009","New","PPO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967598&libID=4294967598","http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0170008-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$0","$0","$3,000","$0","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","1","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0170009","SmartHealth Value Silver 2000","23603MT017",,"MTN001","MTS001","MTF010","New","PPO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967597&libID=4294967597","http://www.exchangepay.pacificsource.com/FFE/Employer/",,"http://www.pacificsource.com/drug-list/","23603MT0170009-01","Standard Silver On Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$0","$1,600","$0","$2,000","$0","$1,000","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6250","23603MT015",,"MTN001","MTS001","MTF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967571&libID=4294967571","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150005-00","Standard Bronze Off Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200002","Dental Choice Core","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"On the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$38.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,"http://www.exchangepay.pacificsource.com/FFE/Employer/","http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200002-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6250","23603MT015",,"MTN001","MTS001","MTF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967571&libID=4294967571","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150005-01","Standard Bronze On Exchange Plan",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,300","$0","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6250","23603MT015",,"MTN001","MTS001","MTF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967571&libID=4294967571","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150005","SmartHealth Value Bronze 6250","23603MT015",,"MTN001","MTS001","MTF006","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967571&libID=4294967571","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150005-03","Limited Cost Sharing Plan Variation",,"0.583353817462921","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,250","$12,500","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,300","$0","$0","$0","$5,300","$0","$0","$40","7"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3000","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967570&libID=4294967570","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150006-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,200","$0","$3,000","$0","$1,100","$40","8"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150006","SmartHealth Value Bronze 3000","23603MT015",,"MTN001","MTS001","MTF003","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967570&libID=4294967570","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150006-03","Limited Cost Sharing Plan Variation",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$2,200","$0","$3,000","$0","$1,100","$40","11"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-00","Standard Silver Off Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","12"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-01","Standard Silver On Exchange Plan",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","13"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","14"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-03","Limited Cost Sharing Plan Variation",,"0.683036506175995","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,600","$7,200",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,600","$7,200","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,600","$0","$0","$0","$3,600","$0","$0","$40","15"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-04","73% AV Level Silver Plan",,"0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,700","$0","$0","$0","$2,600","$0","$0","$40","16"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$0","$0","$0","$1,000","$0","$0","$40","17"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150007","SmartHealth Value Silver 3600","23603MT015",,"MTN001","MTS001","MTF007","New","PPO","Silver","No","Both","No","No",,,"$50.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967573&libID=4294967573","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150007-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$0","$0","$0","$500","$0","$0","$40","18"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","21"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$3,000","$0","$0","$0","$3,000","$0","$0","$40","22"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-04","73% AV Level Silver Plan",,"0.738942980766296","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,650","$5,300",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,650","$5,300","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,700","$0","$0","$0","$2,600","$0","$0","$40","23"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","2","23603","MT","Individual","No","93-0245545","23603MT0150008","SmartHealth Value Silver 3000","23603MT015",,"MTN001","MTS001","MTF008","New","PPO","Silver","No","Both","No","No",,,"$45.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967572&libID=4294967572","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0150008-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,000","$0","$0","$0","$1,000","$0","$0","$40","24"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","SHOP (Small Group)","No","93-0245545","23603MT0180013","SmartHealth Balance Gold 1000","23603MT018",,"MTN001","MTS001","MTF017","New","PPO","Gold","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967593&libID=4294967593","http://www.exchangepay.pacificsource.com/FFE/Employer/",,"http://www.pacificsource.com/drug-list/","23603MT0180013-01","Standard Gold On Exchange Plan",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$50","$0","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-03","Limited Cost Sharing Plan Variation",,"0.703477382659912","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$2,300","$0","$40","7"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-04","73% AV Level Silver Plan",,"0.731934487819672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$1,500","$20","$1,700","$0","$1,400","$1,700","$0","$40","8"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-05","87% AV Level Silver Plan",,"0.864844441413879","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$0","$500","$1,000","$200","$40","9"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","3","23603","MT","Individual","No","93-0245545","23603MT0160006","SmartHealth Balance Silver 1500","23603MT016",,"MTN001","MTS001","MTF011","New","PPO","Silver","No","Both","No","No",,,"$45.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","0","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967567&libID=4294967567","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160006-06","94% AV Level Silver Plan",,"0.932429790496826","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$300","$0","$500","$0","$300","$400","$100","$40","10"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-00","Standard Silver Off Exchange Plan",,"0.68484628200531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,700","$0","$2,200","$1,900","$0","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200003","Dental Choice 0/20/20/50 25/1000","23603MT020",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-01","Standard Silver On Exchange Plan",,"0.68484628200531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,700","$0","$2,200","$1,900","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200004","Dental Choice 0/20/20/50 50/1000","23603MT020",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200004-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$40","6"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-03","Limited Cost Sharing Plan Variation",,"0.68484628200531","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,500","$20","$1,700","$0","$2,200","$1,900","$0","$40","7"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-04","73% AV Level Silver Plan",,"0.734280407428741","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$20","$1,600","$0","$2,000","$900","$50","$40","8"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-05","87% AV Level Silver Plan",,"0.860113680362701","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$500","$20","$1,400","$0","$500","$800","$300","$40","9"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","4","23603","MT","Individual","No","93-0245545","23603MT0160005","SmartHealth Balance Silver 2500","23603MT016",,"MTN001","MTS001","MTF012","New","PPO","Silver","No","Both","No","No",,,"$50.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967568&libID=4294967568","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160005-06","94% AV Level Silver Plan",,"0.930591523647308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$300","$0","$500","$0","$300","$300","$200","$40","10"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","5","23603","MT","Individual","No","93-0245545","23603MT0160007","SmartHealth Balance Gold 1000","23603MT016",,"MTN002","MTS001","MTF017","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,"$250","0","0","0","2014-01-01",,"Yes","Emergency services only","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967566&libID=4294967566","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160007-01","Standard Gold On Exchange Plan",,"0.782167911529541","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$1,300","$0","$1,000","$1,600","$80","$40","4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","Individual","No","93-0245545","23603MT0160004","SmartHealth Balance Bronze 6350","23603MT016",,"MTN001","MTS001","MTF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, Pregnancy",,"0.998633214754534",,,"0","0","3","2014-01-01",,"Yes","Emergency services only.","Yes","PacificSource has contracts with providers in several service areas and states; as well as an extended national network. Services received from these providers are paid at participating benefit levels. Services received from nonparticipating providers not contracted with PacificSource or its extended network are paid at nonparticipating benefit levels.","Yes","http://www.pacificsource.com/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=4294967565&libID=4294967565","http://www.exchangepay.pacificsource.com/FFE/Individual/","http://www.pacificsource.com/montana-individual-plan-details/","http://www.pacificsource.com/drug-list/","23603MT0160004-01","Standard Bronze On Exchange Plan",,"0.610944986343384","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$24,000","$48,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$200","$0","$40","5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","6","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210002","Dental Choice Plus 0/20/20/50 50/1000","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560020","Blue Preferred Silver PPO 020","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560020-00","Standard Silver Off Exchange Plan","71.60%","0.71602863073349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550002","Blue Preferred Gold PPO 002","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-04","73% AV Level Silver Plan","73.91%","0.739054918289185","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-01","Standard Silver On Exchange Plan","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","3","71788","MT","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","71788MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010004",,"71788MT0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","92216","SERFF","1","2013-08-01 21:15:43","1","92216","MT","SHOP (Small Group)","Yes","94-0242990","92216MT0030002","EHB High Passive","92216MT003",,"MTN001","MTS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.32",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","www.standard.com","www.standard.com","www.standard.com",,"92216MT0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0200003","Bronze Essential #2 HMO Alegent Creighton Health Plan S","15438NE020",,"NEN002","NES002","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982345991498516",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39042","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0200003-01","Standard Bronze On Exchange Plan","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10","$0","$200","$4,000","$500","$0","$40","8"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","8"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","9"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0220003","Bronze Essential #2 HMO Plan S","15438NE022",,"NEN004","NES001","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.983708436349071",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39050","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0220003-01","Standard Bronze On Exchange Plan","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10","$0","$200","$4,000","$500","$0","$40","9"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","10"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","12"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","13"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","7","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210003","Dental Choice Plus 0/20/20/50 25/1500","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210003-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","7","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0210004","Dental Choice Plus 0/20/20/50 50/1500","23603MT021",,"MTN003","MTS002",,"New","Indemnity","Low",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$0.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0210004-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","9","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200007","Dental Choice 0/20/20/50 50/1000 1000 Ortho","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$35.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200007-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","23603","SERFF","8","2013-10-16 19:58:29","10","23603","MT","SHOP (Small Group)","Yes","93-0245545","23603MT0200008","Dental Choice 0/20/20/50 50/1500 1000 Ortho","23603MT020",,"MTN003","MTS002",,"New","Indemnity","High",,"Off the Exchange",,,,"Aesthetic dental procedures. Antimicrobial agents. Athletic activities. Benefits not stated  unless essential health benefits by the Affordable Care Act. Biopsies or histopathologic exams. Bone grafts to prepare for implants after extraction. Broken appointments. Collection of cultures and specimens. Connector bar or stress breaker. Core build ups unless endodontically. Cosmetic, reconstructive services and supplies except replacement of congenitally missing teeth. Denture replacement due to loss, theft, or breakage. Diagnostic casts. Drugs. Educational programs. Experimental or investigational procedures. Fractures of the mandible and related surgery. General anesthesia except with oral surgery. Gingivetomcy, gingivoplasty or crown lengthening for crown preparation or fixed bridge services done on the same date. Hospital or additional fees charged by dentist for hospital treatment. Hypnosis. Indirect pulp caps. Infection control. Intra and extra coronal splinting. Orthodontic services not specifically listed as covered. Orthognathic surgery. Photographic images. Precision attachments. Pulpotomies on permanent teeth. Removal of serviceable amalgam restorations replaced by other materials free of mercury, except proof of allergy. Services covered by medical plan. Services for rebuilding or maintaining chewing surfaces. Services otherwise available. Services or supplies with no charge. Services or supplies provided outside of the United States, except emergency. Sinus lift grafts for implants. Stress or habit breaking appliances. Temporomandibular joint services. Third party liability. Tooth transplantation except reimplantation into original socket after avulsed. Treatment after insurance ends. Treatment not dentally necessary. Treatment prior to enrollment. Treatment while incarcerated. Unwilling to release information. War related conditions. Work related conditions.",,,,,"Allows Adult and Child-Only",,,,"$35.82",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency care only.","Yes","This plan covers eligible services when performed by an eligible provider and when determined to be necessary by the generally accepted dental practice standards for the prevention or treatment of oral disease or for accidental injury, including masticatory function. Covered services may also be provided by a dental hygienist or denturist to the extent that he or she is operating within the scope of his or her license as required under law.","Yes",,,"http://www.pacificsource.com/montana-small-group-plan-details/",,"23603MT0200008-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590001","BlueCare Dental 1A","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590001-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-01","Standard Gold On Exchange Plan","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550001","Blue Preferred Gold PPO 001","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$3,250","$6,500","0%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590001","BlueCare Dental 1A","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590001-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560005","Blue Preferred Gold PPO 005","30751MT056",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560005-01","Standard Gold On Exchange Plan","79.04%","0.790639460086823","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550001","Blue Preferred Gold PPO 001","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$3,250","$6,500","0%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","Yes","81-0216685","30751MT0580001","BlueCare Dental 1A","30751MT058",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$52.59",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580001-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590002","BlueCare Dental 1B","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590002-00","Standard Low Off Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","Yes","81-0216685","30751MT0580002","BlueCare Dental 1B","30751MT058",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580002-00","Standard Low Off Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560006","Blue Preferred Gold PPO 006","30751MT056",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560006-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550001","Blue Preferred Gold PPO 001","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570001","Blue Cross Blue Shield Premier 1, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570001-03","Limited Cost Sharing Plan Variation","81.72%","0.817188739776611","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590002","BlueCare Dental 1B","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590002-01","Standard Low On Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","Yes","81-0216685","30751MT0580002","BlueCare Dental 1B","30751MT058",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580002-01","Standard Low On Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-01","Standard Gold On Exchange Plan","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550001","Blue Preferred Gold PPO 001","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$6,500",,,"$6,500","$13,000","Not Applicable","Not Applicable","$3,250","$6,500","0%",,,,"$6,500","$13,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560014","Blue Preferred Silver PPO 014","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560014-00","Standard Silver Off Exchange Plan","70.55%","0.705506205558777","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550002","Blue Preferred Gold PPO 002","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560014","Blue Preferred Silver PPO 014","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560014-01","Standard Silver On Exchange Plan","70.55%","0.705506205558777","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560015","Blue Preferred Silver PPO 015","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560015-00","Standard Silver Off Exchange Plan","71.45%","0.714487671852112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550002","Blue Preferred Gold PPO 002","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570002","Blue Cross Blue Shield Premier 2, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570002-03","Limited Cost Sharing Plan Variation","80.81%","0.80812656879425","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550002","Blue Preferred Gold PPO 002","30751MT055",,"MTN001","MTS001","MTF001","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-01","Standard Silver On Exchange Plan","70.32%","0.703163325786591","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560015","Blue Preferred Silver PPO 015","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560015-01","Standard Silver On Exchange Plan","71.45%","0.714487671852112","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","6","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590008","BlueCare Dental 1F","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590008-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","6","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590008","BlueCare Dental 1F","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.85",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590008-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050001","Connected Care_Platinum","32225MT005",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-PLN/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050001-00","Standard Platinum Off Exchange Plan",,"0.899137020111084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","10%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","1","32225","MT","Individual","No","45-1295465","32225MT0030001","Access Care_Catastrophic","32225MT003",,"MTN002","MTS001","MTF001","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","3","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHS-AccessCareCatastrophic","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare/individual","www.mhc.coop","32225MT0030001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$13,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","1","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050001","Connected Care_Platinum","32225MT005",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-PLN/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050001-01","Standard Platinum On Exchange Plan",,"0.899137020111084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","10%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","1","32225","MT","Individual","No","45-1295465","32225MT0030001","Access Care_Catastrophic","32225MT003",,"MTN002","MTS001","MTF001","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","3","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHS-AccessCareCatastrophic","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare/individual","www.mhc.coop","32225MT0030001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$8,000","$13,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050002","Connected Care_Gold","32225MT005",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-GLD/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050002-00","Standard Gold Off Exchange Plan",,"0.78104293346405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","30%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care_Gold","32225MT001",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010001-00","Standard Gold Off Exchange Plan",,"0.782232403755188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care_Gold","32225MT001",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010001-01","Standard Gold On Exchange Plan",,"0.782232403755188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050002","Connected Care_Gold","32225MT005",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-GLD/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050002-01","Standard Gold On Exchange Plan",,"0.78104293346405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","30%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care_Gold","32225MT001",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","2","32225","MT","Individual","No","45-1295465","32225MT0010001","Access Care_Gold","32225MT001",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010001-03","Limited Cost Sharing Plan Variation",,"0.782232403755188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050003","Connected Care_Silver","32225MT005",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-SIL/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050003-00","Standard Silver Off Exchange Plan",,"0.690834283828735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-00","Standard Silver Off Exchange Plan",,"0.692710638046265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-05","87% AV Level Silver Plan","86.82%","0.868183553218842","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","Not Applicable","Not Applicable","$250","$500","20%",,,,"$500","$1,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570003","Blue Cross Blue Shield Solution 3, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570003-06","94% AV Level Silver Plan","94.68%","0.946778774261475","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-03","Limited Cost Sharing Plan Variation","70.79%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$6,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0050003","Connected Care_Silver","32225MT005",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3400-SIL/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/business","www.mhc.coop","32225MT0050003-01","Standard Silver On Exchange Plan",,"0.690834283828735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-01","Standard Silver On Exchange Plan",,"0.692710638046265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","3","32225","MT","Individual","No","45-1295465","32225MT0010002","Access Care_Silver","32225MT001",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09//MHC-3000-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010002-03","Limited Cost Sharing Plan Variation",,"0.692710638046265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550003","Blue Preferred Silver PPO 003","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550003-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-03","Limited Cost Sharing Plan Variation","68.66%","0.686640679836273","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable","$6,250","$12,500","0%",,,,"$12,500","$25,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care_Gold","32225MT002",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020002-01","Standard Gold On Exchange Plan",,"0.78104293346405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","30%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care_Gold","32225MT002",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care_Gold","32225MT002",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020002-03","Limited Cost Sharing Plan Variation",,"0.78104293346405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","30%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040003","Access Care_Bronze","32225MT004",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/individual","www.mhc.coop","32225MT0040003-00","Standard Bronze Off Exchange Plan",,"0.58912068605423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-00","Standard Silver Off Exchange Plan",,"0.690834283828735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-01","Standard Silver On Exchange Plan",,"0.690834283828735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040003","Access Care_Bronze","32225MT004",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/connectedcare/individual","www.mhc.coop","32225MT0040003-01","Standard Bronze On Exchange Plan",,"0.58912068605423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","7","32225","MT","Individual","No","45-1295465","32225MT0020003","Connected Care_Silver","32225MT002",,"MTN001","MTS001","MTF007","New","POS","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-SIL/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","8","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care_Bronze","32225MT002",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","8","32225","MT","Individual","No","45-1295465","32225MT0020004","Connected Care_Bronze","32225MT002",,"MTN001","MTS001","MTF008","New","POS","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020004-03","Limited Cost Sharing Plan Variation",,"0.612320065498352","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","46668","SERFF","1","2013-08-01 21:15:43","1","46668","MT","SHOP (Small Group)","Yes","47-0397286","46668MT0060001","Renaissance Group Dental Indemnity, EHB Certified","46668MT006",,"MTN001","MTS001",,"New","Indemnity","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.21",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46668MT0060001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","46668","SERFF","1","2013-08-01 21:15:43","1","46668","MT","SHOP (Small Group)","Yes","47-0397286","46668MT0060002","Renaissance Group Dental Indemnity, EHB Certified","46668MT006",,"MTN001","MTS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"46668MT0060002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0010001","Guardian Pediatric Advantage","62818MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0010001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0010001","Guardian Pediatric Advantage","62818MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0010001-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-04","73% AV Level Silver Plan","72.29%","0.722892880439758","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$10,000","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-00","Standard Silver Off Exchange Plan","70.11%","0.701061606407166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-01","Standard Silver On Exchange Plan","70.11%","0.701061606407166","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-05","87% AV Level Silver Plan","87.13%","0.871323525905609","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0570004","Blue Cross Blue Shield Solution 4, a Multi-State Plan","30751MT057",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","www.bcbsmt.com",,,"https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0570004-06","94% AV Level Silver Plan","94.57%","0.94565761089325","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$3,000","$6,000","Not Applicable","Not Applicable","$1,500","$3,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","1","30751","MT","Individual","No","81-0216685","30751MT0550004","Blue Preferred Silver PPO 004","30751MT055",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside or service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other grographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550004-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550005","Blue Preferred Bronze PPO 005","30751MT055",,"MTN001","MTS001","MTF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590003","BlueCare Dental 4 Kids 1A","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.49",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590003-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590004","BlueCare Dental 4 Kids 1B","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590004-01","Standard Low On Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","Yes","81-0216685","30751MT0580004","BlueCare Dental 4 Kids 1B","30751MT058",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$43.98",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/coverage_individual_onexchange_dental.aspx",,"30751MT0580004-01","Standard Low On Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550006","Blue Preferred Bronze PPO 006","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550006","Blue Preferred Bronze PPO 006","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550006","Blue Preferred Bronze PPO 006","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","2","30751","MT","Individual","No","81-0216685","30751MT0550006","Blue Preferred Bronze PPO 006","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560021","Blue Preferred Silver PPO 021","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560021-00","Standard Silver Off Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590005","BlueCare Dental 1C","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590005-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","Individual","No","81-0216685","30751MT0550007","Blue Preferred Security PPO 007","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550007-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","SHOP (Small Group)","No","81-0216685","30751MT0560021","Blue Preferred Silver PPO 021","30751MT056",,"MTN001","MTS001","MTF002","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area(""Host Blue"").  In some instances, you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0560021-01","Standard Silver On Exchange Plan","70.86%","0.708627700805664","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","Individual","No","81-0216685","30751MT0550007","Blue Preferred Security PPO 007","30751MT055",,"MTN001","MTS001","MTF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement(i.e., are ""Participating Providers"") with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obtain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://retailweb.hcsc.net/retailshoppingcart2/MT/exchange_referred","https://www.bcbsmt.com/pages/coverage_individual_onexchange.aspx","https://www.bcbsmt.com/SiteCollectionDocuments/pharmacy/MT5tierpharmacy.pdf","30751MT0550007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","3","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590005","BlueCare Dental 1C","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590005-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","4","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590006","BlueCare Dental 1D","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.77",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590006-00","Standard Low Off Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","4","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590006","BlueCare Dental 1D","30751MT059",,"MTN002","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.77",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590006-01","Standard Low On Exchange Plan","70.72%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","5","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590007","BlueCare Dental 1E","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590007-00","Standard High Off Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","30751","SERFF","6","2014-01-21 11:24:32","5","30751","MT","SHOP (Small Group)","Yes","81-0216685","30751MT0590007","BlueCare Dental 1E","30751MT059",,"MTN002","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.30",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Covered subject to the conditions and limitations of the Contract.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual  agreement (i.e., are ""Participating Providers"") with the local Blue Cross and Blue Shield Licensee in that other geographic area (""Host Blue"").  In some instances you may obrain care from Non-Participating Providers.","Yes","https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"https://www.bcbsmt.com/pages/employer_products_onexchange_dental.aspx",,"30751MT0590007-01","Standard High On Exchange Plan","85.89%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$50",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","4","32225","MT","Individual","No","45-1295465","32225MT0010003","Access Care_Bronze","32225MT001",,"MTN002","MTS001","MTF004","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3000-BRZ/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/accesscare","www.mhc.coop","32225MT0010003-03","Limited Cost Sharing Plan Variation",,"0.58912068605423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,950","$7,900","50%",,,,"$7,900","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","Individual","No","45-1295465","32225MT0020001","Connected Care_Platinum","32225MT002",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-PLN/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020001-00","Standard Platinum Off Exchange Plan",,"0.899137020111084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","10%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040001","Access Care_Gold","32225MT004",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3300-GLD/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/accesscare/business","www.mhc.coop","32225MT0040001-00","Standard Gold Off Exchange Plan",,"0.782232403755188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040001","Access Care_Gold","32225MT004",,"MTN002","MTS001","MTF002","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3300-GLD/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/accesscare/business","www.mhc.coop","32225MT0040001-01","Standard Gold On Exchange Plan",,"0.782232403755188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","Individual","No","45-1295465","32225MT0020001","Connected Care_Platinum","32225MT002",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-PLN/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020001-01","Standard Platinum On Exchange Plan",,"0.899137020111084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","10%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","Individual","No","45-1295465","32225MT0020001","Connected Care_Platinum","32225MT002",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-PLN/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","5","32225","MT","Individual","No","45-1295465","32225MT0020001","Connected Care_Platinum","32225MT002",,"MTN001","MTS001","MTF005","New","POS","Platinum","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-PLN/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020001-03","Limited Cost Sharing Plan Variation",,"0.899137020111084","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$2,400","$4,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$700","10%",,,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","Individual","No","45-1295465","32225MT0020002","Connected Care_Gold","32225MT002",,"MTN001","MTS001","MTF006","New","POS","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9899",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3100-GLD/SBC.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.mhc.coop/plans/connectedcare","www.mhc.coop","32225MT0020002-00","Standard Gold Off Exchange Plan",,"0.78104293346405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$7,500","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","30%",,,,"$1,400","$2,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040002","Access Care_Silver","32225MT004",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3300-SIL/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/accesscare/business","www.mhc.coop","32225MT0040002-00","Standard Silver Off Exchange Plan",,"0.692710638046265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","MT","32225","SERFF","3","2013-08-26 12:29:34","6","32225","MT","SHOP (Small Group)","No","45-1295465","32225MT0040002","Access Care_Silver","32225MT004",,"MTN002","MTS001","MTF003","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.9921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Emergency Only","Yes","http://www.mhc.coop/wp-content/uploads/2013/09/MHC-3300-SIL/SBC.pdf","https://marketplace.mhc.coop/ehp/eapp/samlpaymentacs","http://www.mhc.coop/plans/accesscare/business","www.mhc.coop","32225MT0040002-01","Standard Silver On Exchange Plan",,"0.692710638046265","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$15,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","40%",,,,"$3,500","$7,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0020001","Guardian Pediatric Essentials","62818MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","1","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0020001","Guardian Pediatric Essentials","62818MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0030001","Guardian Family Advantage Plus","62818MT003",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0030001-00","Standard High Off Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","2","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0030001","Guardian Family Advantage Plus","62818MT003",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0030001-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","4","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0040001","Guardian Family Advantage","62818MT004",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0040001-01","Standard High On Exchange Plan","83.80%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","4","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0060001","Guardian Family Essentials","62818MT006",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","62818","SERFF","2","2013-09-11 14:31:09","4","62818","MT","SHOP (Small Group)","Yes","13-5123390","62818MT0060001","Guardian Family Essentials","62818MT006",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"62818MT0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","Individual","Yes","94-2761537","71788MT0010001","Delta Dental PPO Plan 70 for Children","71788MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010001",,"71788MT0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$35","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020001",,"71788MT0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","Individual","Yes","94-2761537","71788MT0010001","Delta Dental PPO Plan 70 for Children","71788MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010001",,"71788MT0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$35","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020001",,"71788MT0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.32",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020002",,"71788MT0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","Individual","Yes","94-2761537","71788MT0010002","Delta Dental PPO Plan 85 for Children","71788MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010002",,"71788MT0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","Individual","Yes","94-2761537","71788MT0010002","Delta Dental PPO Plan 85 for Children","71788MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010002",,"71788MT0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","1","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.32",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020002",,"71788MT0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","2","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020006",,"71788MT0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","2","71788","MT","Individual","Yes","94-2761537","71788MT0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","71788MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010006",,"71788MT0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","2","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.11",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020006",,"71788MT0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","2","71788","MT","Individual","Yes","94-2761537","71788MT0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","71788MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.94",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010006",,"71788MT0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$45","Not Applicable",,,,,"$45","Not Applicable","$45","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","3","71788","MT","Individual","Yes","94-2761537","71788MT0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","71788MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/mt/71788mt0010004",,"71788MT0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","3","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.32",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020004",,"71788MT0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","71788","SERFF","5","2014-01-21 11:24:32","3","71788","MT","SHOP (Small Group)","Yes","94-2761537","71788MT0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","71788MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.32",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/mt/71788mt0020004",,"71788MT0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,200","$2,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","14"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0170002","Silver $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.980148846007437",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73109","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","15"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","16"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","18"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","19"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","Individual","Yes","95-6042390","93895MT0020004","BESTOne Dental Plus - Gold","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"93895MT0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010004","BEST Dental Plus - Gold","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Gold).pdf",,"93895MT0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","Individual","Yes","95-6042390","93895MT0020004","BESTOne Dental Plus - Gold","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"93895MT0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010005","BEST Dental Plus - Silver","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Silver).pdf",,"93895MT0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","Individual","Yes","95-6042390","93895MT0020005","BESTOne Dental Plus - Silver","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_Silver).pdf",,"93895MT0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010005","BEST Dental Plus - Silver","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Silver).pdf",,"93895MT0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0180003","Bronze $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978142621790787",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73129","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0180003","Bronze $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978142621790787",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73129","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","15"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","4","15438","NE","Individual","No","42-1308659","15438NE0150004","Catastrophic 100% HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.958921170961053",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73106","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","4","15438","NE","Individual","No","42-1308659","15438NE0170004","Catastrophic 100% HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.961130804385742",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73114","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","5"
"2014","MT","92216","SERFF","1","2013-08-01 21:15:43","1","92216","MT","SHOP (Small Group)","Yes","94-0242990","92216MT0030001","EHB Low Passive","92216MT003",,"MTN001","MTS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.12",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","www.standard.com","www.standard.com","www.standard.com",,"92216MT0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","4","15438","NE","Individual","No","42-1308659","15438NE0180004","Catastrophic 100% POS Plan","15438NE018",,"NEN003","NES001","NEF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.965012303543041",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73130","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0150005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972673262612893",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73152","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0150005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972673262612893",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73152","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0150005","Bronze Deductible Only HMO HSA Eligible Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.972673262612893",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73152","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","6"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010001","BEST Life Child Dental Plus","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plus_Plan.pdf",,"93895MT0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","1","93895","MT","Individual","Yes","95-6042390","93895MT0020001","BESTOne Child Dental Plus","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plus_Plan.pdf",,"93895MT0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","1","93895","MT","Individual","Yes","95-6042390","93895MT0020001","BESTOne Child Dental Plus","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plus_Plan.pdf",,"93895MT0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","1","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010001","BEST Life Child Dental Plus","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plus_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plus_Plan.pdf",,"93895MT0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","2","93895","MT","Individual","Yes","95-6042390","93895MT0020002","BESTOne Child Dental","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plan.pdf",,"93895MT0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010002","BEST Life Child Dental","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plan.pdf",,"93895MT0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","2","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010002","BEST Life Child Dental","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Child_Dental_Plan.pdf",,"93895MT0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","2","93895","MT","Individual","Yes","95-6042390","93895MT0020002","BESTOne Child Dental","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plan.pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Child_Dental_Plan.pdf",,"93895MT0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010003","BEST Dental Advantage - Gold","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Advantage_Plan_(Gold).pdf",,"93895MT0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","Individual","Yes","95-6042390","93895MT0020003","BESTOne Dental Advantage - Gold","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"93895MT0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","Individual","Yes","95-6042390","93895MT0020003","BESTOne Dental Advantage - Gold","93895MT002",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$48.36",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"93895MT0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010003","BEST Dental Advantage - Gold","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Advantage_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Advantage_Plan_(Gold).pdf",,"93895MT0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","3","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010004","BEST Dental Plus - Gold","93895MT001",,"MTN001","MTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.69",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Gold).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Plus_Plan_(Gold).pdf",,"93895MT0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","Individual","Yes","95-6042390","93895MT0020005","BESTOne Dental Plus - Silver","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Plus_Plan_Silver).pdf",,"93895MT0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","Individual","Yes","95-6042390","93895MT0020006","BESTOne Dental Basic - Silver","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"93895MT0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010006","BEST Dental Basic - Silver","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Basic_Plan_(Silver).pdf",,"93895MT0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","SHOP (Small Group)","Yes","95-6042390","93895MT0010006","BEST Dental Basic - Silver","93895MT001",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BEST_Dental_Basic_Plan_(Silver).pdf",,"93895MT0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","MT","93895","SERFF","5","2014-01-22 11:51:12","4","93895","MT","Individual","Yes","95-6042390","93895MT0020006","BESTOne Dental Basic - Silver","93895MT002",,"MTN001","MTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Basic_Plan_(Silver).pdf","http://www.bestlife.com/pmt","http://www.bestlife.com/MT/pdf/MT_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"93895MT0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$700","$1,400",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0190001","Gold Freedom #3 HMO Methodist Health Partners Plan S","15438NE019",,"NEN001","NES002","NEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986281556885029",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39044","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0190001-01","Standard Gold On Exchange Plan","78.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$100","$700","$200","$300","$2,100","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0150001","Gold $5 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981527860766521",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0200001","Gold Freedom #3 HMO Alegent Creighton Health Plan S","15438NE020",,"NEN002","NES002","NEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.986870249790571",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39040","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0200001-01","Standard Gold On Exchange Plan","78.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$100","$700","$200","$300","$2,100","$0","$40","5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0150001","Gold $5 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981527860766521",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0150001","Gold $5 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981527860766521",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73100","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0220001","Gold Freedom #3 HMO Plan S","15438NE022",,"NEN004","NES001","NEF001","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.98793780939705",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39048","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0220001-01","Standard Gold On Exchange Plan","78.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$100","$700","$200","$300","$2,100","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0170001","Gold $5 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982480722485109",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73108","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0170001","Gold $5 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982480722485109",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73108","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0170001","Gold $5 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982480722485109",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73108","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","9"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0160001","Gold $5 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981910223188689",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73116","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","10"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0160001","Gold $5 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981910223188689",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73116","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0160001","Gold $5 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981910223188689",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73116","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","12"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0180001","Gold $5 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.984165347319845",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73124","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","13"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0180001","Gold $5 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.984165347319845",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73124","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","1","15438","NE","Individual","No","42-1308659","15438NE0180001","Gold $5 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF003","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.984165347319845",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73124","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,800","$300","$600","$200","$500","$1,400","$0","$40","15"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0190002","Silver Security #2 HMO Methodist Health Partners Plan S","15438NE019",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.983987949937977",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39045","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0190002-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$10","$0","$200","$2,500","$900","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0200002","Silver Security #2 HMO Alegent Creighton Health Plan S","15438NE020",,"NEN002","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.984656545632008",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39041","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0200002-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$10","$0","$200","$2,500","$900","$0","$40","5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0220002","Silver Security #2 HMO Plan S","15438NE022",,"NEN004","NES001","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.985873135993036",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39049","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0220002-01","Standard Silver On Exchange Plan","68.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$10","$0","$200","$2,500","$900","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0150002","Silver $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.979063835448842",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73101","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0190003","Bronze Essential #2 HMO Methodist Health Partners Plan S","15438NE019",,"NEN001","NES002","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981599895911506",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39046","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0190003-01","Standard Bronze On Exchange Plan","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$10","$0","$200","$4,000","$500","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","20"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0160002","Silver $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.97949929253559",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73117","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","21"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","22"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","24"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-04","73% AV Level Silver Plan","74.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$800","$100","$200","$1,400","$1,500","$0","$40","25"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$300","$0","$200","$300","$1,900","$0","$40","26"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","2","15438","NE","Individual","No","42-1308659","15438NE0180002","Silver $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF002","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982065756658312",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73125","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$300","$500","$200","$0","$1,400","$30","$40","27"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0190004","Bronze Essential #5 HMO Methodist Health Partners Plan S","15438NE019",,"NEN001","NES002","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.981773778260702",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39047","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0190004-01","Standard Bronze On Exchange Plan","59.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$80","$0","$200","$3,500","$200","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0150003","Bronze $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974450442649577",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73105","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","4"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0200004","Bronze Essential #5 HMO Alegent Creighton Health Plan S","15438NE020",,"NEN002","NES002","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.982514427337056",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39043","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0200004-01","Standard Bronze On Exchange Plan","59.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$80","$0","$200","$3,500","$200","$0","$40","5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0150003","Bronze $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974450442649577",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73105","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0150003","Bronze $10 Copay HMO Methodist Health Partners","15438NE015",,"NEN001","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974450442649577",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73105","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmomethodistne","www.c1formularyhix.com","15438NE0150003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","SHOP (Small Group)","No","42-1308659","15438NE0220004","Bronze Essential #5 HMO Plan S","15438NE022",,"NEN004","NES001","NEF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.983866575745365",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE39051","http://chcnebraska.coventryhealthcare.com/make-payment","http://chcnebraska.coventryhealthcare.com/services-and-support/brokers/broker-tool-kit/plan-grids/index.htm?toolSelectorSubmit=Submit","http://chcnebraska.coventryhealthcare.com/health-care-solutions/prescription-coverage/formulary/index.htm","15438NE0220004-01","Standard Bronze On Exchange Plan","59.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$80","$0","$200","$3,500","$200","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0170003","Bronze $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975786060239409",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73113","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0170003","Bronze $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975786060239409",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73113","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0170003","Bronze $10 Copay HMO Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.975786060239409",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73113","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","9"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0160003","Bronze $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974986630753964",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73121","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","10"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0160003","Bronze $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974986630753964",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73121","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0160003","Bronze $10 Copay POS MIPPA","15438NE016",,"NEN004","NES002","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974986630753964",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73121","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","12"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","3","15438","NE","Individual","No","42-1308659","15438NE0180003","Bronze $10 Copay POS Plan","15438NE018",,"NEN003","NES001","NEF001","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.978142621790787",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73129","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$4,100","$1,100","$0","$200","$3,400","$600","$0","$40","13"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","4","15438","NE","Individual","No","42-1308659","15438NE0160004","Catastrophic 100% POS MIPPA","15438NE016",,"NEN004","NES002","NEF004","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.959809084913297",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73122","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$60","$0","$200","$4,800","$60","$0","$40","6"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0170005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974106526324593",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73155","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","7"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0170005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974106526324593",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73155","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0170005","Bronze Deductible Only HMO HSA Eligible Alegent Creighton Health","15438NE017",,"NEN002","NES002","NEF004","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.974106526324593",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73155","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/hmoalegentcreightonne","www.c1formularyhix.com","15438NE0170005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","9"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0160005","Bronze Deductible Only POS HSA Eligible MIPPA","15438NE016",,"NEN004","NES002","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973248714156402",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73158","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","10"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0160005","Bronze Deductible Only POS HSA Eligible MIPPA","15438NE016",,"NEN004","NES002","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973248714156402",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73158","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0160005","Bronze Deductible Only POS HSA Eligible MIPPA","15438NE016",,"NEN004","NES002","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.973248714156402",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73158","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posmippane","www.c1formularyhix.com","15438NE0160005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","12"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0180005","Bronze Deductible Only POS HSA Eligible Plan","15438NE018",,"NEN003","NES001","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976634094659025",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73161","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180005-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","13"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0180005","Bronze Deductible Only POS HSA Eligible Plan","15438NE018",,"NEN003","NES001","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976634094659025",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73161","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","NE","15438","SERFF","5","2013-10-15 10:04:03","5","15438","NE","Individual","No","42-1308659","15438NE0180005","Bronze Deductible Only POS HSA Eligible Plan","15438NE018",,"NEN003","NES001","NEF004","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.976634094659025",,,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","http://www.coventryhealthcare.com/NE73161","https://ssoprod.healthplan.com/sp/ACS.saml2","http://www.coventryone.com/posne","www.c1formularyhix.com","15438NE0180005-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$6,300","$0","$0","$200","$5,200","$0","$0","$40","15"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1030001","BlueEssentialsPlus $1000 Gold","29678NE103",,"NEN001","NES003","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1000gold_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1030001-00","Standard Gold Off Exchange Plan","78.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$10","$1,250","$150","$1,000","$420","$40","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1030001","BlueEssentialsPlus $1000 Gold","29678NE103",,"NEN001","NES003","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1000gold_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1030001-03","Limited Cost Sharing Plan Variation","78.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$10","$1,250","$150","$1,000","$420","$40","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-03","Limited Cost Sharing Plan Variation","70.33%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,500","$10","$950","$150","$2,500","$220","$80","$80","11"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-00","Standard Silver Off Exchange Plan","70.33%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,500","$10","$950","$150","$2,500","$220","$80","$80","8"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-01","Standard Silver On Exchange Plan","70.33%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,500","$10","$950","$150","$2,500","$220","$80","$80","9"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220001","BluePridePlus Option 301 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF008","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp301HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220001-01","Standard Bronze On Exchange Plan","60.91%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","$16,350","$36,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$6,500","$13,000","$2,500","$0","$2,390","$150","$2,500","$0","$1,390","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220002","BluePridePlus Option 302 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF008","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp302HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220002-00","Standard Bronze Off Exchange Plan","59.86%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","$18,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","$9,000","$17,000","$3,000","$0","$2,140","$150","$3,000","$0","$1,140","$80","6"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210007","CoOportunity Premier HSA Bronze","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210007-01","Standard Bronze On Exchange Plan","60.60%","0.611596345901489","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-01","Standard Silver On Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210004","CoOportunity Premier Bronze","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210004-00","Standard Bronze Off Exchange Plan","61.50%","0.636123239994049","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210004","CoOportunity Premier Bronze","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210004-01","Standard Bronze On Exchange Plan","61.50%","0.636123239994049","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-03","Limited Cost Sharing Plan Variation","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220004","BluePridePlus Option 305 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF010","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp305HDHPbronze_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220004-01","Standard Bronze On Exchange Plan","58.01%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"$15,000","$30,000","$21,100","$42,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","35%",,,,"$10,000","$20,000","$15,000","$30,000","$5,000","$0","$800","$150","$5,000","$0","$90","$80","10"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentialsPlus $2500 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100001-00","Standard Bronze Off Exchange Plan","60.91%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$1,500","$2,500","$0","$2,390","$150","$2,500","$0","$1,390","$80","11"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-04","73% AV Level Silver Plan","73.13%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","$17,700","$35,400","$2,000","$4,000","20%",,,,"$5,000","$10,000","$7,000","$14,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$10","$1,050","$150","$2,000","$270","$80","$80","12"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1330001","SelectBluePlus Option 402 HDHP Silver","29678NE133",,"NEN001","NES001","NEF012","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp402HDHPsilver_sbc",,"nebraskablue.com/three_tier","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1330001-00","Standard Silver Off Exchange Plan","70.42%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,350","$12,700","$12,000","$24,000","$16,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$2,000","$4,000","30%","$4,000","$8,000","$5,500","$11,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-03","Limited Cost Sharing Plan Variation","68.69%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","$7,500","$15,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980001","SelectBluePlus $2750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980001-01","Standard Bronze On Exchange Plan","60.94%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,600",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","40%","$5,000","$10,000","50%","$10,000","$20,000","$12,750","$25,250","$2,750","$0","$1,810","$150","$2,750","$0","$1,010","$80","12"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","3","29678","NE","Individual","No","47-0095156","29678NE1050004","BlueEssentialsPlus $5500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep5500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050004-00","Standard Bronze Off Exchange Plan","60.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$5,500","$0","$360","$150","$5,270","$0","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100003","BlueEssentialsPlus $4750 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4750HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100003-01","Standard Bronze On Exchange Plan","58.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"$9,500","$19,000","$14,250","$28,500","$4,750","$0","$250","$150","$4,750","$0","$50","$80","20"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100003","BlueEssentialsPlus $4750 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4750HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","21"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","3","29678","NE","Individual","No","47-0095156","29678NE1050004","BlueEssentialsPlus $5500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep5500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050004-01","Standard Bronze On Exchange Plan","60.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$5,500","$0","$360","$150","$5,270","$0","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-06","94% AV Level Silver Plan","94.27%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$400","$800","$600","$1,200","$12,000","$24,000","$12,400","$24,800",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%","$300","$600","10%","$6,000","$12,000","$6,200","$12,400","$200","$0","$200","$150","$200","$0","$200","$80","10"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980001","SelectBluePlus $2750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980001-00","Standard Bronze Off Exchange Plan","60.94%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,600",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","40%","$5,000","$10,000","50%","$10,000","$20,000","$12,750","$25,250","$2,750","$0","$1,810","$150","$2,750","$0","$1,010","$80","11"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210005","CoOportunity Premier HSA Gold","43198NE021",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210005-00","Standard Gold Off Exchange Plan","78.50%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200006","CoOportunity Premier HSA Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$80.86","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200006-00","Standard Gold Off Exchange Plan","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200006","CoOportunity Premier HSA Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$80.86","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200006-01","Standard Gold On Exchange Plan","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210005","CoOportunity Premier HSA Gold","43198NE021",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210005-01","Standard Gold On Exchange Plan","78.50%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-00","Standard Silver Off Exchange Plan","68.80%","0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-01","Standard Silver On Exchange Plan","68.80%","0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-03","Limited Cost Sharing Plan Variation","68.80%","0.687443435192108","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$16,000","$32,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-04","73% AV Level Silver Plan","73.70%","0.737065613269806","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,600","$9,200",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,300","$4,600","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-05","87% AV Level Silver Plan","87.50%","0.874881386756897","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,350","$2,700",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$675","$1,350","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980001","SelectBluePlus $2750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBluePlus $4750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980002-01","Standard Bronze On Exchange Plan","58.18%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","1%","$6,350","$12,700","0%","$12,700","$25,400","$17,450","$34,900","$4,750","$0","$0","$150","$4,750","$0","$0","$80","16"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBluePlus $4750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200001","CoOportunity Premier Platinum","43198NE020",,"NEN001","NES001","NEF003","New","PPO","Platinum","Yes","Both","No","No",,,"$41.19","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200001-01","Standard Platinum On Exchange Plan","88.30%","0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210001","CoOportunity Premier Platinum","43198NE021",,"NEN001","NES001","NEF003","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210001-01","Standard Platinum On Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","Individual","No","47-0095156","29678NE0940001","SelectBluePlus $4500 Bronze","29678NE094",,"NEN002","NES002","NEF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4500bronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0940001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","Individual","No","47-0095156","29678NE0940001","SelectBluePlus $4500 Bronze","29678NE094",,"NEN002","NES002","NEF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4500bronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0940001-03","Limited Cost Sharing Plan Variation","61.96%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%","$6,350","$12,700","1%","$12,700","$25,400","$17,200","$34,400","$4,500","$10","$830","$150","$4,500","$80","$0","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","Individual","No","47-0095156","29678NE1050002","BlueEssentialsPlus $4000 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050002-00","Standard Bronze Off Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$10","$980","$150","$4,000","$120","$30","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1140002","BluePridePlus Option 202 Silver","29678NE114",,"NEN001","NES001","NEF015","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp202silver_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1140002-00","Standard Silver Off Exchange Plan","68.63%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$14,000","$28,000","$20,350","$40,700","$2,000","$4,000","30%",,,,"$5,000","$10,000","$7,000","$14,000","$0","$0","30%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,580","$150","$2,000","$500","$130","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","Individual","No","47-0095156","29678NE1050002","BlueEssentialsPlus $4000 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050002-01","Standard Bronze On Exchange Plan","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$10","$980","$150","$4,000","$120","$30","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1140002","BluePridePlus Option 202 Silver","29678NE114",,"NEN001","NES001","NEF015","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp202silver_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1140002-01","Standard Silver On Exchange Plan","68.63%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$14,000","$28,000","$20,350","$40,700","$2,000","$4,000","30%",,,,"$5,000","$10,000","$7,000","$14,000","$0","$0","30%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$2,000","$20","$1,580","$150","$2,000","$500","$130","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980001","SelectBluePlus $2750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980001-03","Limited Cost Sharing Plan Variation","60.94%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$6,350","$12,700","$12,700","$25,400","$18,200","$36,400",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","40%","$5,000","$10,000","50%","$10,000","$20,000","$12,750","$25,250","$2,750","$0","$1,810","$150","$2,750","$0","$1,010","$80","14"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBluePlus $4750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980002-00","Standard Bronze Off Exchange Plan","58.18%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","1%","$6,350","$12,700","0%","$12,700","$25,400","$17,450","$34,900","$4,750","$0","$0","$150","$4,750","$0","$0","$80","15"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1330001","SelectBluePlus Option 402 HDHP Silver","29678NE133",,"NEN001","NES001","NEF012","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp402HDHPsilver_sbc",,"nebraskablue.com/three_tier","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1330001-01","Standard Silver On Exchange Plan","70.42%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,350","$12,700","$12,000","$24,000","$16,000","$34,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$2,000","$4,000","30%","$4,000","$8,000","$5,500","$11,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","Individual","No","47-0095156","29678NE1050003","BlueEssentialsPlus $4500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","Individual","No","47-0095156","29678NE1050003","BlueEssentialsPlus $4500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050003-03","Limited Cost Sharing Plan Variation","61.08%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$4,500","$10","$830","$150","$4,500","$80","$0","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1030001","BlueEssentialsPlus $1000 Gold","29678NE103",,"NEN001","NES003","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1000gold_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1030001-01","Standard Gold On Exchange Plan","78.83%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$10","$1,250","$150","$1,000","$420","$40","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1030001","BlueEssentialsPlus $1000 Gold","29678NE103",,"NEN001","NES003","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1000gold_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1030001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-00","Standard Silver Off Exchange Plan","70.96%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","$12,000","$24,000","$0","$0","30%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$2,000","$10","$1,580","$150","$2,000","$270","$130","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1260001","SelectBluePlus Option 401 Gold","29678NE126",,"NEN001","NES001","NEF015","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","www.nebraskablue.com/sbcs","http://payments.nebraskablue.com","http://payments.nebraskablue.com","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1260001-01","Standard Gold On Exchange Plan","79.19%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,000","$6,000","$4,500","$12,000","$12,000","$24,000","$14,000","$30,000","$1,000","$2,000","20%","$2,000","$4,000","30%","$4,000","$8,000","$5,000","$10,000","$0","$0","20%","$0","$0","30%","$0","$0","$0","$0",,,,,,,,,,,"$1,000","$0","$1,000","$150","$1,000","$100","$740","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-01","Standard Silver On Exchange Plan","70.96%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","$12,000","$24,000","$0","$0","30%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$2,000","$10","$1,580","$150","$2,000","$270","$130","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-01","Standard Silver On Exchange Plan","68.69%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","$7,500","$15,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1340001","SelectBluePlus Option 403 HDHP Bronze","29678NE134",,"NEN001","NES001","NEF012","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp403HDHPbronze_sbc",,"nebraskablue.com/three_tier","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1340001-01","Standard Bronze On Exchange Plan","58.94%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$15,000","$30,000","$21,000","$4,200",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%","$5,500","$11,000","30%","$11,000","$22,000","$15,000","$30,000","$4,000","$0","$660","$150","$4,000","$0","$250","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-05","87% AV Level Silver Plan","87.06%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","$14,200","$28,400","$750","$1,500","20%",,,,"$5,000","$10,000","$5,750","$11,500","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$750","$0","$750","$150","$750","$320","$200","$80","13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","1","29678","NE","Individual","No","47-0095156","29678NE1040001","BlueEssentialsPlus $2500 Silver","29678NE104",,"NEN001","NES003","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1040001-06","94% AV Level Silver Plan","93.69%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$450","$900",,,"$12,700","$25,400","$13,150","$26,300","$225","$450","10%",,,,"$5,000","$10,000","$5,225","$10,450","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$225","$10","$215","$150","$225","$150","$75","$80","14"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1260001","SelectBluePlus Option 401 Gold","29678NE126",,"NEN001","NES001","NEF015","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","www.nebraskablue.com/sbcs","http://payments.nebraskablue.com","http://payments.nebraskablue.com","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1260001-00","Standard Gold Off Exchange Plan","79.19%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,000","$6,000","$4,500","$12,000","$12,000","$24,000","$14,000","$30,000","$1,000","$2,000","20%","$2,000","$4,000","30%","$4,000","$8,000","$5,000","$10,000","$0","$0","20%","$0","$0","30%","$0","$0","$0","$0",,,,,,,,,,,"$1,000","$0","$1,000","$150","$1,000","$100","$740","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-03","Limited Cost Sharing Plan Variation","70.96%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,350","$12,700","$12,700","$25,400","$17,700","$35,400","$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","$12,000","$24,000","$0","$0","30%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$2,000","$10","$1,580","$150","$2,000","$270","$130","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-04","73% AV Level Silver Plan","73.37%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$5,200","$10,400","$12,700","$25,400","$16,700","$33,400","$2,000","$4,000","30%","$4,000","$8,000","50%","$8,000","$16,000","$12,000","$24,000","$0","$0","30%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$2,000","$10","$1,580","$150","$2,000","$270","$130","$80","8"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-05","87% AV Level Silver Plan","86.71%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,100","$2,200","$2,200","$4,400","$12,700","$25,400","$13,800","$27,600","$550","$1,100","20%","$1,100","$2,200","50%","$8,000","$16,000","$8,550","$17,100","$0","$0","20%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$550","$0","$550","$150","$550","$320","$230","$80","9"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0930001","SelectBluePlus $2000 Silver","29678NE093",,"NEN002","NES002","NEF006","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp2000silver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0930001-06","94% AV Level Silver Plan","93.93%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$350","$700","$700","$1,400","$12,700","$25,400","$13,050","$26,100","$175","$350","20%","$350","$700","50%","$8,000","$16,000","$8,175","$16,350","$0","$0","20%","$0","$0","50%","$0","$0","$0","$0",,,,,,,,,,,"$175","$0","$200","$150","$150","$70","$130","$80","10"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-05","87% AV Level Silver Plan","87.92%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,500","$3,000","$12,000","$24,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%","$750","$1,500","20%","$6,000","$12,000","$6,500","$13,000","$500","$0","$500","$150","$500","$0","$480","$80","9"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200004","CoOportunity Premier Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","No","Both","No","No",,,"$165.17","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200004-03","Limited Cost Sharing Plan Variation",,"0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200005","CoOportunity Premier Catastrophic","43198NE020",,"NEN001","NES001","NEF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200005-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200005","CoOportunity Premier Catastrophic","43198NE020",,"NEN001","NES001","NEF004","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210002","CoOportunity Premier Gold","43198NE021",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210002-00","Standard Gold Off Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020002","BESTOne Child Dental","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Child_Dental_Plan.pdf",,"50022NE0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010002","BEST Life Child Dental","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Child_Dental_Plan.pdf",,"50022NE0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020003","BESTOne Dental Advantage - Gold","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"50022NE0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010003","BEST Dental Advantage - Gold","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Advantage_Plan_(Gold).pdf",,"50022NE0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020003","BESTOne Dental Advantage - Gold","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"50022NE0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010003","BEST Dental Advantage - Gold","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Advantage_Plan_(Gold).pdf",,"50022NE0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020004","BESTOne Dental Plus - Gold","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"50022NE0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010004","BEST Dental Plus - Gold","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Plus_Plan_(Gold).pdf",,"50022NE0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0920001","SelectBluePlus $750 Gold","29678NE092",,"NEN002","NES002","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp750gold_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0920001-00","Standard Gold Off Exchange Plan","79.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000","$750","$1,500","10%","$2,000","$4,000","20%","$4,000","$8,000","$4,750","$9,500","$0","$0","10%","$0","$0","20%","$0","$0","$0","$0",,,,,,,,,,,"$750","$10","$650","$150","$750","$320","$100","$80","11"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0920001","SelectBluePlus $750 Gold","29678NE092",,"NEN002","NES002","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp750gold_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0920001-01","Standard Gold On Exchange Plan","79.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000","$750","$1,500","10%","$2,000","$4,000","20%","$4,000","$8,000","$4,750","$9,500","$0","$0","10%","$0","$0","20%","$0","$0","$0","$0",,,,,,,,,,,"$750","$10","$650","$150","$750","$320","$100","$80","12"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0920001","SelectBluePlus $750 Gold","29678NE092",,"NEN002","NES002","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp750gold_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0920001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$150","$0","$0","$0","$80","13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","2","29678","NE","Individual","No","47-0095156","29678NE0920001","SelectBluePlus $750 Gold","29678NE092",,"NEN002","NES002","NEF006","New","PPO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp750gold_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0920001-03","Limited Cost Sharing Plan Variation","79.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$2,500","$5,000","$5,000","$10,000","$10,000","$20,000","$12,500","$25,000","$750","$1,500","10%","$2,000","$4,000","20%","$4,000","$8,000","$4,750","$9,500","$0","$0","10%","$0","$0","20%","$0","$0","$0","$0",,,,,,,,,,,"$750","$10","$650","$150","$750","$320","$100","$80","14"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","3","29678","NE","Individual","No","47-0095156","29678NE1050004","BlueEssentialsPlus $5500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep5500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","3","29678","NE","Individual","No","47-0095156","29678NE1050004","BlueEssentialsPlus $5500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep5500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050004-03","Limited Cost Sharing Plan Variation","60.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$11,000","$22,000","$16,500","$33,000","$5,500","$0","$360","$150","$5,270","$0","$0","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120003","BluePridePlus Option 103 Gold","29678NE112",,"NEN001","NES001","NEF015","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","www.nebraskablue.com/sbcs","http://payments.nebraskablue.com","http://payments.nebraskablue.com","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1120003-00","Standard Gold Off Exchange Plan","78.51%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,000","$14,000","$10,000","$20,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,500","$20","$1,150","$150","$1,500","$630","$40","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","Individual","No","47-0095156","29678NE0940001","SelectBluePlus $4500 Bronze","29678NE094",,"NEN002","NES002","NEF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4500bronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0940001-00","Standard Bronze Off Exchange Plan","61.96%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%","$6,350","$12,700","1%","$12,700","$25,400","$17,200","$34,400","$4,500","$10","$830","$150","$4,500","$80","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1120003","BluePridePlus Option 103 Gold","29678NE112",,"NEN001","NES001","NEF015","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$100","0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","www.nebraskablue.com/sbcs","http://payments.nebraskablue.com","http://payments.nebraskablue.com","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1120003-01","Standard Gold On Exchange Plan","78.51%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$7,000","$14,000","$10,000","$20,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,500","$20","$1,150","$150","$1,500","$630","$40","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","4","29678","NE","Individual","No","47-0095156","29678NE0940001","SelectBluePlus $4500 Bronze","29678NE094",,"NEN002","NES002","NEF007","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4500bronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0940001-01","Standard Bronze On Exchange Plan","61.96%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","20%","$6,350","$12,700","1%","$12,700","$25,400","$17,200","$34,400","$4,500","$10","$830","$150","$4,500","$80","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","Individual","No","47-0095156","29678NE1050002","BlueEssentialsPlus $4000 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","5","29678","NE","Individual","No","47-0095156","29678NE1050002","BlueEssentialsPlus $4000 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050002-03","Limited Cost Sharing Plan Variation","61.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$10","$980","$150","$4,000","$120","$30","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","6","29678","NE","Individual","No","47-0095156","29678NE1050001","BlueEssentialsPlus $3500 Bronze","29678NE105",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep3500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050001-00","Standard Bronze Off Exchange Plan","61.07%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$7,000","$14,000","$10,500","$21,000","$3,500","$0","$1,890","$150","$3,500","$8","$890","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","6","29678","NE","Individual","No","47-0095156","29678NE1050001","BlueEssentialsPlus $3500 Bronze","29678NE105",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep3500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050001-01","Standard Bronze On Exchange Plan","61.07%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$7,000","$14,000","$10,500","$21,000","$3,500","$0","$1,890","$150","$3,500","$8","$890","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","6","29678","NE","Individual","No","47-0095156","29678NE1050001","BlueEssentialsPlus $3500 Bronze","29678NE105",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep3500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","6","29678","NE","Individual","No","47-0095156","29678NE1050001","BlueEssentialsPlus $3500 Bronze","29678NE105",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep3500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050001-03","Limited Cost Sharing Plan Variation","61.07%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","50%",,,,"$7,000","$14,000","$10,500","$21,000","$3,500","$0","$1,890","$150","$3,500","$8","$890","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","Individual","No","47-0095156","29678NE1050003","BlueEssentialsPlus $4500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050003-00","Standard Bronze Off Exchange Plan","61.08%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$4,500","$10","$830","$150","$4,500","$80","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220001","BluePridePlus Option 301 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF008","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp301HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220001-00","Standard Bronze Off Exchange Plan","60.91%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","$16,350","$36,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$6,500","$13,000","$2,500","$0","$2,390","$150","$2,500","$0","$1,390","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","Individual","No","47-0095156","29678NE1050003","BlueEssentialsPlus $4500 Bronze","29678NE105",,"NEN001","NES001","NEF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4500bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1050003-01","Standard Bronze On Exchange Plan","61.08%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"$9,000","$18,000","$13,500","$27,000","$4,500","$10","$830","$150","$4,500","$80","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220002","BluePridePlus Option 302 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF008","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp302HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220002-01","Standard Bronze On Exchange Plan","59.86%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$24,000","$18,350","$32,700",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$6,000","$12,000","$9,000","$17,000","$3,000","$0","$2,140","$150","$3,000","$0","$1,140","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220003","BluePridePlus Option 304 HDHP  Bronze","29678NE122",,"NEN001","NES001","NEF009","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp303bronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220003-00","Standard Bronze Off Exchange Plan","58.53%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$8,000","$16,000","$8,000","$16,000","$4,000","$0","$1,310","$150","$4,000","$0","$510","$80","8"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-03","Limited Cost Sharing Plan Variation","68.26%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,080","$150","$1,900","$0","$650","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-04","73% AV Level Silver Plan","72.63%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$12,700","$25,400","$17,300","$34,600",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$4,000","$8,000","$5,500","$11,000","$1,500","$0","$1,160","$150","$15,000","$0","$750","$80","8"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220004","BluePridePlus Option 305 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF010","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp305HDHPbronze_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220004-00","Standard Bronze Off Exchange Plan","58.01%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,100","$12,200",,,"$15,000","$30,000","$21,100","$42,200",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","35%",,,,"$10,000","$20,000","$15,000","$30,000","$5,000","$0","$800","$150","$5,000","$0","$90","$80","9"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-05","87% AV Level Silver Plan","87.38%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","$13,950","$27,900",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$4,000","$8,000","$4,500","$9,000","$500","$0","$750","$150","$500","$0","$750","$80","9"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-06","94% AV Level Silver Plan","94.37%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","$13,200","$26,400",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$4,000","$8,000","$4,200","$8,400","$200","$0","$300","$150","$200","$0","$300","$80","10"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-04","73% AV Level Silver Plan","73.90%","0.742269039154053","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"$5,500","$11,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-05","87% AV Level Silver Plan","86.20%","0.86322146654129","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$600","$1,200","10%",,,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","7","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220003","BluePridePlus Option 304 HDHP  Bronze","29678NE122",,"NEN001","NES001","NEF009","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp303bronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220003-01","Standard Bronze On Exchange Plan","58.53%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$8,000","$16,000","$8,000","$16,000","$4,000","$0","$1,310","$150","$4,000","$0","$510","$80","9"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-00","Standard Silver Off Exchange Plan","68.69%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$6,000","$12,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%","$3,000","$6,000","40%","$6,000","$12,000","$7,500","$15,000","$1,500","$0","$1,160","$150","$1,500","$0","$750","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1340001","SelectBluePlus Option 403 HDHP Bronze","29678NE134",,"NEN001","NES001","NEF012","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp403HDHPbronze_sbc",,"nebraskablue.com/three_tier","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1340001-00","Standard Bronze Off Exchange Plan","58.94%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,350","$12,700","$15,000","$30,000","$21,000","$4,200",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%","$5,500","$11,000","30%","$11,000","$22,000","$15,000","$30,000","$4,000","$0","$660","$150","$4,000","$0","$250","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0970001","SelectBluePlus $1500 HDHP Silver","29678NE097",,"NEN002","NES002","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp1500HDHPsilver_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0970001-04","73% AV Level Silver Plan","72.75%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$4,500","$9,000","$12,000","$24,000","$15,000","$30,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","20%","$2,500","$5,000","30%","$6,000","$12,000","$7,250","$14,500","$1,250","$0","$1,210","$150","$1,250","$0","$800","$80","8"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020004","BESTOne Dental Plus - Gold","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"50022NE0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010004","BEST Dental Plus - Gold","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Plus_Plan_(Gold).pdf",,"50022NE0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","4","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0200001","Pediatric Dental A and Adult Dental C","45550NE020",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0200001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","4","45550","NE","Individual","Yes","47-0685003","45550NE0040001","Pediatric Dental A and Adult Dental C","45550NE004",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0040001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","5","45550","NE","Individual","Yes","47-0685003","45550NE0050001","Pediatric Dental A and Adult Dental D","45550NE005",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0050001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","5","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0210001","Pediatric Dental A and Adult Dental D","45550NE021",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0210001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","5","45550","NE","Individual","Yes","47-0685003","45550NE0050001","Pediatric Dental A and Adult Dental D","45550NE005",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0050001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","5","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0210001","Pediatric Dental A and Adult Dental D","45550NE021",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0210001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","6","45550","NE","Individual","Yes","47-0685003","45550NE0060001","Pediatric Dental A and Adult Dental E","45550NE006",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0060001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","6","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0220001","Pediatric Dental A and Adult Dental E","45550NE022",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0220001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","Individual","No","45-3468530","43198NE0200002","CoOportunity Premier Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$84.31","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200002-00","Standard Gold Off Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","Individual","No","45-3468530","43198NE0200002","CoOportunity Premier Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$84.31","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200002-01","Standard Gold On Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210002","CoOportunity Premier Gold","43198NE021",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210002-01","Standard Gold On Exchange Plan","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","Individual","No","45-3468530","43198NE0200002","CoOportunity Premier Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$84.31","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010006","BEST Dental Basic - Silver","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Basic_Plan_(Silver).pdf",,"50022NE0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020006","BESTOne Dental Basic - Silver","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"50022NE0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4D/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4D/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0020001","Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2","77931NE002","7659374889","NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/19X/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/19X/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0020001-00","Standard Gold Off Exchange Plan","78.70%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,600","$10","$400","$200","$600","$700","$60","$80","4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210006","CoOportunity Premier HSA Silver","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210006-00","Standard Silver Off Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200006","CoOportunity Premier HSA Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$80.86","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200008","CoOportunity Premier HSA Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$171.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200008-00","Standard Bronze Off Exchange Plan","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200008","CoOportunity Premier HSA Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$171.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200008-01","Standard Bronze On Exchange Plan","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200008","CoOportunity Premier HSA Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$171.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200008","CoOportunity Premier HSA Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$171.76","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200008-03","Limited Cost Sharing Plan Variation","58.30%","0.59650319814682","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$20,000","$40,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","3","26075","NM","Individual","Yes","95-6042390","26075NM0020003","BESTOne Dental Advantage - Gold","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"26075NM0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","3","26075","NM","Individual","Yes","95-6042390","26075NM0020004","BESTOne Dental Plus - Gold","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"26075NM0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-05","87% AV Level Silver Plan","86.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,000","$22,000","$12,850","$25,700","$150","$300","20%",,,,"$4,800","$9,600","$4,950","$9,900","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$150","$20","$1,200","$200","$150","$900","$200","$80","9"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,000","$22,000","$12,850","$25,700","$0","$0","3%",,,,"$4,800","$9,600","Not Applicable","Not Applicable","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$0","$20","$200","$200","$0","$800","$20","$80","10"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0050001","Guardian Family Advantage Plus","24847NH005",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0050001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","2","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0050001","Guardian Family Advantage Plus","24847NH005",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0050001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","3","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0070001","Guardian Family Essentials Plus","24847NH007",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0070001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","3","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0070001","Guardian Family Essentials Plus","24847NH007",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0070001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","4","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0060001","Guardian Family Advantage","24847NH006",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0060001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","4","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0060001","Guardian Family Advantage","24847NH006",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0060001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","1","57601","NH","Individual","Yes","02-0510530","57601NH0400001","Anthem Dental Pediatric","57601NH040",,"NHN001","NHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$30.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155870.pdf",,,,"57601NH0400001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","1","57601","NH","Individual","Yes","02-0510530","57601NH0400052","Anthem Dental Pediatric Enhanced","57601NH040",,"NHN001","NHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213348.pdf",,,,"57601NH0400052-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","1","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0370002","Anthem Dental Pediatric Enhanced","57601NH037",,"NHN001","NHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$33.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/nh/f0/s0/t0/pw_e213348.pdf",,,,"57601NH0370002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","2","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390001","Anthem Dental Family","57601NH039",,"NHN001","NHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155851.pdf",,,,"57601NH0390001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","8"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","11","45550","NE","Individual","Yes","47-0685003","45550NE0110001","Pediatric Dental B and Adult Dental B","45550NE011",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0110001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","11","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0270001","Pediatric Dental B and Adult Dental B","45550NE027",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0270001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","11","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0270001","Pediatric Dental B and Adult Dental B","45550NE027",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0270001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200006","CoOportunity Premier HSA Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$80.86","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200006-03","Limited Cost Sharing Plan Variation","78.90%","0.79376745223999","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,400","$8,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210006","CoOportunity Premier HSA Silver","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210006-01","Standard Silver On Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210007","CoOportunity Premier HSA Bronze","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210007-00","Standard Bronze Off Exchange Plan","60.60%","0.611596345901489","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,200","$6,400","40%",,,,"$6,500","$13,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-00","Standard Silver Off Exchange Plan","68.40%","0.686291456222534","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","15","45550","NE","Individual","Yes","47-0685003","45550NE0150001","Pediatric Dental B and Adult Dental F","45550NE015",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0150001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","15","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0310001","Pediatric Dental B and Adult Dental F","45550NE031",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0310001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","15","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0310001","Pediatric Dental B and Adult Dental F","45550NE031",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0310001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020005","BESTOne Dental Plus - Silver","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"50022NE0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010005","BEST Dental Plus - Silver","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Plus_Plan_(Silver).pdf",,"50022NE0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010005","BEST Dental Plus - Silver","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Plus_Plan_(Silver).pdf",,"50022NE0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","8","29678","NE","Individual","No","47-0095156","29678NE0980002","SelectBluePlus $4750 HDHP Bronze","29678NE098",,"NEN002","NES002","NEF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/m_sbp4750HDHPbronze_sbc",,"nebraskablue.com/selectblueplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE0980002-03","Limited Cost Sharing Plan Variation","58.18%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$6,350","$12,700","$12,700","$25,400","$17,950","$35,900",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","1%","$6,350","$12,700","0%","$12,700","$25,400","$17,450","$34,900","$4,750","$0","$0","$150","$4,750","$0","$0","$80","18"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1200002","BluePridePlus Option 106 HDHP Gold","29678NE120",,"NEN001","NES001","NEF014","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp106HDHPgold_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1200002-00","Standard Gold Off Exchange Plan","78.43%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$8,000","$16,000","$9,900","$19,800",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","1%",,,,"$4,000","$8,000","$5,900","$11,800","$1,900","$0","$0","$150","$1,900","$0","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-00","Standard Silver Off Exchange Plan","68.26%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,080","$150","$1,900","$0","$650","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1200002","BluePridePlus Option 106 HDHP Gold","29678NE120",,"NEN001","NES001","NEF014","New","PPO","Gold","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp106HDHPgold_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1200002-01","Standard Gold On Exchange Plan","78.43%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,900","$3,800",,,"$8,000","$16,000","$9,900","$19,800",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","1%",,,,"$4,000","$8,000","$5,900","$11,800","$1,900","$0","$0","$150","$1,900","$0","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-01","Standard Silver On Exchange Plan","68.26%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$1,900","$3,800","20%",,,,"$3,800","$7,600","$5,700","$11,400","$1,900","$0","$1,080","$150","$1,900","$0","$650","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1210001","BluePridePlus Option 203 HDHP Silver","29678NE121",,"NEN001","NES001","NEF011","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp203HDHPsilver_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1210001-00","Standard Silver Off Exchange Plan","68.17%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$8,000","$16,000","$12,400","$24,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,580","$150","$2,000","$0","$980","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1090001","BlueEssentialsPlus $1900 HDHP Silver","29678NE109",,"NEN001","NES003","NEF003","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep1900HDHPsilver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1090001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1210001","BluePridePlus Option 203 HDHP Silver","29678NE121",,"NEN001","NES001","NEF011","New","PPO","Silver","Yes","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp203HDHPsilver_sbc",,"nebraskablue.com/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1210001-01","Standard Silver On Exchange Plan","68.17%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,400","$8,800",,,"$8,000","$16,000","$12,400","$24,800",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$1,580","$150","$2,000","$0","$980","$80","7"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentialsPlus $2500 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100001-01","Standard Bronze On Exchange Plan","60.91%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$1,500","$2,500","$0","$2,390","$150","$2,500","$0","$1,390","$80","12"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentialsPlus $2500 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","13"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100001","BlueEssentialsPlus $2500 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF001","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep2500silver_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100001-03","Limited Cost Sharing Plan Variation","60.91%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$5,000","$10,000","$7,500","$1,500","$2,500","$0","$2,390","$150","$2,500","$0","$1,390","$80","14"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100002","BlueEssentialsPlus $4000 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100002-00","Standard Bronze Off Exchange Plan","58.53%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$0","$1,310","$150","$4,000","$0","$510","$80","15"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100002","BlueEssentialsPlus $4000 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100002-01","Standard Bronze On Exchange Plan","58.53%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$0","$1,310","$150","$4,000","$0","$510","$80","16"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100002","BlueEssentialsPlus $4000 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100002","BlueEssentialsPlus $4000 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF002","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4000bronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100002-03","Limited Cost Sharing Plan Variation","58.53%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$0","$1,310","$150","$4,000","$0","$510","$80","18"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100003","BlueEssentialsPlus $4750 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4750HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100003-00","Standard Bronze Off Exchange Plan","58.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"$9,500","$19,000","$14,250","$28,500","$4,750","$0","$250","$150","$4,750","$0","$50","$80","19"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","9","29678","NE","Individual","No","47-0095156","29678NE1100003","BlueEssentialsPlus $4750 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF004","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep4750HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100003-03","Limited Cost Sharing Plan Variation","58.33%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"$9,500","$19,000","$14,250","$28,500","$4,750","$0","$250","$150","$4,750","$0","$50","$80","22"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","10","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220005","BluePridePlus Option 306 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF011","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp306HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220005-00","Standard Bronze Off Exchange Plan",,"0.58379852771759","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%",,,,"$11,000","$22,000","$16,500","$33,000","$5,500","$0","$530","$150","$5,270","$0","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","10","29678","NE","Individual","No","47-0095156","29678NE1060001","BlueEssentialsPlus $6350 Catastrophic","29678NE106",,"NEN001","NES001","NEF005","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","Nebraskablue.com/bepcatastrophic_sbc",,"nebraskablue.com/catastrophic","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1060001-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","10","29678","NE","Individual","No","47-0095156","29678NE1060001","BlueEssentialsPlus $6350 Catastrophic","29678NE106",,"NEN001","NES001","NEF005","New","PPO","Catastrophic","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","Nebraskablue.com/bepcatastrophic_sbc",,"nebraskablue.com/catastrophic","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1060001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,050","$38,100","$6,350","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","10","29678","NE","SHOP (Small Group)","No","47-0095156","29678NE1220005","BluePridePlus Option 306 HDHP Bronze","29678NE122",,"NEN001","NES001","NEF011","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bpp306HDHPbronze_sbc",,"nebraskabluecom/blueprideplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1220005-01","Standard Bronze On Exchange Plan",,"0.58379852771759","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","$21,350","$42,700",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%",,,,"$11,000","$22,000","$16,500","$33,000","$5,500","$0","$530","$150","$5,270","$0","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","11","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentialsPlus $6325 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep6325HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100004-00","Standard Bronze Off Exchange Plan",,"0.580779373645782","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,700","$25,400","$19,025","$38,050",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650","1%",,,,"$12,700","$25,400","$19,025","$38,050","$6,325","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","11","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentialsPlus $6325 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep6325HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100004-01","Standard Bronze On Exchange Plan",,"0.580779373645782","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,700","$25,400","$19,025","$38,050",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650","1%",,,,"$12,700","$25,400","$19,025","$38,050","$6,325","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","11","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentialsPlus $6325 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep6325HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","1%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","NE","29678","SERFF","4","2013-10-15 10:04:03","11","29678","NE","Individual","No","47-0095156","29678NE1100004","BlueEssentialsPlus $6325 HDHP Bronze","29678NE110",,"NEN001","NES001","NEF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically necessary services that would normally be payable under the plan if rendered in the United States are also payable when received out of the country.","Yes","Medically necessary covered services are payable under the plan when rendered by an out of network provider.  Benefits for covered services provided by an out of network provider will be based on the out of network allowance and subject to the out of network cost sharing requirements.","Yes","nebraskablue.com/bep6325HDHPbronze_sbc",,"nebraskablue.com/blueessentialsplus","https://www.nebraskablue.com/member-services/pharmacy-tools/prescription-drug-list/","29678NE1100004-03","Limited Cost Sharing Plan Variation",,"0.580779373645782","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,325","$12,650",,,"$12,700","$25,400","$19,025","$38,050",,,,,,,,,,,,,,,,,,,,,"$6,325","$12,650","1%",,,,"$12,700","$25,400","$19,025","$38,050","$6,325","$0","$0","$150","$5,270","$0","$0","$80","7"
"2014","NE","36768","SERFF","1","2013-08-01 21:15:43","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0040002","EHB High PPO","36768NE004",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.68",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"36768NE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","36768","SERFF","1","2013-08-01 21:15:43","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0040001","EHB Low PPO","36768NE004",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.52",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"36768NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","36768","SERFF","1","2013-08-01 21:15:43","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0030002","EHB High Passive","36768NE003",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.16",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"36768NE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","36768","SERFF","1","2013-08-01 21:15:43","1","36768","NE","SHOP (Small Group)","Yes","47-0098400","36768NE0030001","EHB Low Passive","36768NE003",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"36768NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210001","CoOportunity Premier Platinum","43198NE021",,"NEN001","NES001","NEF003","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210001-00","Standard Platinum Off Exchange Plan",,"0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200001","CoOportunity Premier Platinum","43198NE020",,"NEN001","NES001","NEF003","New","PPO","Platinum","Yes","Both","No","No",,,"$41.19","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200001-00","Standard Platinum Off Exchange Plan","88.30%","0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200001","CoOportunity Premier Platinum","43198NE020",,"NEN001","NES001","NEF003","New","PPO","Platinum","Yes","Both","No","No",,,"$41.19","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210003","CoOportunity Premier Silver","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210003-00","Standard Silver Off Exchange Plan",,"0.713157653808594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200001","CoOportunity Premier Platinum","43198NE020",,"NEN001","NES001","NEF003","New","PPO","Platinum","Yes","Both","No","No",,,"$41.19","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200001-03","Limited Cost Sharing Plan Variation","88.30%","0.881199836730957","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$1,000","$2,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","SHOP (Small Group)","No","45-3468530","43198NE0210003","CoOportunity Premier Silver","43198NE021",,"NEN001","NES001","NEF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/Group1-50",,"http://www.cooportunityhealth.com/ShopforInsurance/Group1-50","www.cooportunityhealth.com/druglist","43198NE0210003-01","Standard Silver On Exchange Plan",,"0.713157653808594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","1","43198","NE","Individual","No","45-3468530","43198NE0200003","CoOportunity Premier Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.70","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200003-06","94% AV Level Silver Plan","94.00%","0.940450727939606","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$450","$900",,,"$12,800","$25,600","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$225","$450","30%",,,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200007","CoOportunity Premier HSA Silver","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Silver","Yes","Both","No","No",,,"$64.87","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200007-06","94% AV Level Silver Plan","94.20%","0.943639814853668","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$2,500","$5,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$1,500","$3,000","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200004","CoOportunity Premier Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","No","Both","No","No",,,"$165.17","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200004-00","Standard Bronze Off Exchange Plan",,"0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200004","CoOportunity Premier Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","No","Both","No","No",,,"$165.17","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200004-01","Standard Bronze On Exchange Plan",,"0.605189144611359","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$13,000","$26,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","6","96751","NH","Individual","No","02-0494919","96751NH0150010","Anthem Gold DirectAccess - ccaf","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SB6","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150010-03","Limited Cost Sharing Plan Variation","79.82%","0.805286765098572","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","7","96751","NH","Individual","No","02-0494919","96751NH0150011","Anthem Catastrophic DirectAccess","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SBA","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-01","Standard Silver On Exchange Plan","69.02%","0.683860003948212","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-03","Limited Cost Sharing Plan Variation","69.02%","0.683860003948212","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,250","$6,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-04","73% AV Level Silver Plan","72.07%","0.70810079574585","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-05","87% AV Level Silver Plan","86.09%","0.856367766857147","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0090002","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$30.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.deltadentalnm.com/NM_Ped_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","www.deltadentalnm.com/NM_EHB_Plan_Brochure",,"17911NM0090002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.996273335143344",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","19722NM0010001-01","Standard Gold On Exchange Plan","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010001","Pathfinder POS 20/40 1200.2400 20% 4000/8000 Rx2","77931NE001","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6LZ/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6LZ/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010001-00","Standard Gold Off Exchange Plan","79.30%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4D/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4D/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4D/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4D/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120001-03","Limited Cost Sharing Plan Variation","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4D/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4D/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150001","Anthem Bronze DirectAccess w/HSA - cacc","96751NH015",,"NHN001","NHS001","NHF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAF","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150001-03","Limited Cost Sharing Plan Variation","61.64%","0.621244966983795","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","6","96751","NH","Individual","No","02-0494919","96751NH0150010","Anthem Gold DirectAccess - ccaf","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SB6","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150010-01","Standard Gold On Exchange Plan","79.82%","0.805286765098572","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","6","96751","NH","Individual","No","02-0494919","96751NH0150010","Anthem Gold DirectAccess - ccaf","96751NH015",,"NHN001","NHS001","NHF004","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SB6","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE005","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/22E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/22E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050001-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE005","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/22E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/22E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050001-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060002-00","Standard Gold Off Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","16"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UX/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UX/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","17"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-00","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010001","Pathfinder POS 20/40 1200.2400 20% 4000/8000 Rx2","77931NE001","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6LZ/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6LZ/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010001-01","Standard Gold On Exchange Plan","79.30%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-03","Limited Cost Sharing Plan Variation","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0090003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3P/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3P/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090003-04","73% AV Level Silver Plan","73.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"$11,000","$22,000","$15,850","$31,700","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$500",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","8"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","3","26075","NM","Individual","Yes","95-6042390","26075NM0020003","BESTOne Dental Advantage - Gold","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"26075NM0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","1","87701","NH","Individual","Yes","02-0273013","87701NH0080001","Delta Dental Family Low Plan","87701NH008",,"NHN001","NHS001",,"New","EPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$30.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20142.pdf",,"87701NH0080001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","2","43198","NE","Individual","No","45-3468530","43198NE0200004","CoOportunity Premier Bronze","43198NE020",,"NEN001","NES001","NEF001","New","PPO","Bronze","No","Both","No","No",,,"$165.17","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","NE","43198","SERFF","3","2013-11-27 09:24:34","3","43198","NE","Individual","No","45-3468530","43198NE0200002","CoOportunity Premier Gold","43198NE020",,"NEN001","NES001","NEF002","New","PPO","Gold","Yes","Both","No","No",,,"$84.31","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, Low Back Pain, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Standard In and Out of network coverage applies","Yes","Standard In and Out of network coverage applies","Yes","http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies",,"http://www.cooportunityhealth.com/ShopforInsurance/IndividualsandFamilies","www.cooportunityhealth.com/druglist","43198NE0200002-03","Limited Cost Sharing Plan Variation","78.60%","0.779993414878845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$6,350","$12,700","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,600","$3,200","20%",,,,"$3,200","$6,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","1","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0170001","Pediatric Dental A","45550NE017",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age  19",,,,,"Allows Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","1","45550","NE","Individual","Yes","47-0685003","45550NE0010001","Pediatric Dental A","45550NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age  19",,,,,"Allows Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","1","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0170001","Pediatric Dental A","45550NE017",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age  19",,,,,"Allows Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","1","45550","NE","Individual","Yes","47-0685003","45550NE0010001","Pediatric Dental A","45550NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Dependent age limited to age  19",,,,,"Allows Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","2","45550","NE","Individual","Yes","47-0685003","45550NE0020001","Pediatric Dental A and Adult Dental A","45550NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0020001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","2","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0180001","Pediatric Dental A and Adult Dental A","45550NE018",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","2","45550","NE","Individual","Yes","47-0685003","45550NE0020001","Pediatric Dental A and Adult Dental A","45550NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0020001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","2","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0180001","Pediatric Dental A and Adult Dental A","45550NE018",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","3","45550","NE","Individual","Yes","47-0685003","45550NE0030001","Pediatric Dental A and Adult Dental B","45550NE003",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","3","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0190001","Pediatric Dental A and Adult Dental B","45550NE019",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0190001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","3","45550","NE","Individual","Yes","47-0685003","45550NE0030001","Pediatric Dental A and Adult Dental B","45550NE003",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0030001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","3","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0190001","Pediatric Dental A and Adult Dental B","45550NE019",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0190001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","4","45550","NE","Individual","Yes","47-0685003","45550NE0040001","Pediatric Dental A and Adult Dental C","45550NE004",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","4","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0200001","Pediatric Dental A and Adult Dental C","45550NE020",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0200001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","15","45550","NE","Individual","Yes","47-0685003","45550NE0150001","Pediatric Dental B and Adult Dental F","45550NE015",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0150001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","16","45550","NE","Individual","Yes","47-0685003","45550NE0160001","Pediatric Dental B and Adult Dental G","45550NE016",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","16","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0320001","Pediatric Dental B and Adult Dental G","45550NE032",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0320001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","16","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0320001","Pediatric Dental B and Adult Dental G","45550NE032",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0320001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","16","45550","NE","Individual","Yes","47-0685003","45550NE0160001","Pediatric Dental B and Adult Dental G","45550NE016",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020001","BESTOne Child Dental Plus","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Child_Dental_Plus_Plan.pdf",,"50022NE0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010001","BEST Life Child Dental Plus","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Child_Dental_Plus_Plan.pdf",,"50022NE0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020001","BESTOne Child Dental Plus","50022NE002",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.80",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Child_Dental_Plus_Plan.pdf",,"50022NE0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010001","BEST Life Child Dental Plus","50022NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.84",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Child_Dental_Plus_Plan.pdf",,"50022NE0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020002","BESTOne Child Dental","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Child_Dental_Plan.pdf",,"50022NE0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010002","BEST Life Child Dental","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Child_Dental_Plan.pdf",,"50022NE0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","6","45550","NE","Individual","Yes","47-0685003","45550NE0060001","Pediatric Dental A and Adult Dental E","45550NE006",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0060001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","6","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0220001","Pediatric Dental A and Adult Dental E","45550NE022",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0220001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","7","45550","NE","Individual","Yes","47-0685003","45550NE0070001","Pediatric Dental A and Adult Dental F","45550NE007",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0070001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","7","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0230001","Pediatric Dental A and Adult Dental F","45550NE023",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0230001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","7","45550","NE","Individual","Yes","47-0685003","45550NE0070001","Pediatric Dental A and Adult Dental F","45550NE007",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0070001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","7","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0230001","Pediatric Dental A and Adult Dental F","45550NE023",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0230001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","8","45550","NE","Individual","Yes","47-0685003","45550NE0080001","Pediatric Dental A and Adult Dental G","45550NE008",,"NEN001","NES001",,"New","Indemnity","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0080001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","8","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0240001","Pediatric Dental A and Adult Dental G","45550NE024",,"NEN001","NES001",,"New","Indemnity","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","8","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0240001","Pediatric Dental A and Adult Dental G","45550NE024",,"NEN001","NES001",,"New","Indemnity","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0240001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","8","45550","NE","Individual","Yes","47-0685003","45550NE0080001","Pediatric Dental A and Adult Dental G","45550NE008",,"NEN001","NES001",,"New","Indemnity","Low",,"Both",,,,"Adult annual plan maximum is $1200",,,,,"Allows Adult and Child-Only",,,,"$19.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0080001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","9","45550","NE","Individual","Yes","47-0685003","45550NE0090001","Pediatric Dental B","45550NE009",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0090001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","9","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0250001","Pediatric Dental B","45550NE025",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0250001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","9","45550","NE","Individual","Yes","47-0685003","45550NE0090001","Pediatric Dental B","45550NE009",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0090001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","9","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0250001","Pediatric Dental B","45550NE025",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Dependent age limited to age 19",,,,,"Allows Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0250001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","10","45550","NE","Individual","Yes","47-0685003","45550NE0100001","Pediatric Dental B and Adult Dental A","45550NE010",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0100001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","10","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0260001","Pediatric Dental B and Adult Dental A","45550NE026",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0260001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","10","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0260001","Pediatric Dental B and Adult Dental A","45550NE026",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0260001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","10","45550","NE","Individual","Yes","47-0685003","45550NE0100001","Pediatric Dental B and Adult Dental A","45550NE010",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0100001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","11","45550","NE","Individual","Yes","47-0685003","45550NE0110001","Pediatric Dental B and Adult Dental B","45550NE011",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0110001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","12","45550","NE","Individual","Yes","47-0685003","45550NE0120001","Pediatric Dental B and Adult Dental C","45550NE012",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0120001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","12","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0280001","Pediatric Dental B and Adult Dental C","45550NE028",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0280001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","12","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0280001","Pediatric Dental B and Adult Dental C","45550NE028",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0280001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","12","45550","NE","Individual","Yes","47-0685003","45550NE0120001","Pediatric Dental B and Adult Dental C","45550NE012",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $500",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0120001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","13","45550","NE","Individual","Yes","47-0685003","45550NE0130001","Pediatric Dental B and Adult Dental D","45550NE013",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0130001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","13","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0290001","Pediatric Dental B and Adult Dental D","45550NE029",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0290001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","13","45550","NE","Individual","Yes","47-0685003","45550NE0130001","Pediatric Dental B and Adult Dental D","45550NE013",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0130001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","13","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0290001","Pediatric Dental B and Adult Dental D","45550NE029",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $750",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0290001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","14","45550","NE","Individual","Yes","47-0685003","45550NE0140001","Pediatric Dental B and Adult Dental E","45550NE014",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0140001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","14","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0300001","Pediatric Dental B and Adult Dental E","45550NE030",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0300001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","14","45550","NE","SHOP (Small Group)","Yes","47-0685003","45550NE0300001","Pediatric Dental B and Adult Dental E","45550NE030",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0300001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","45550","SERFF","5","2014-01-21 11:24:32","14","45550","NE","Individual","Yes","47-0685003","45550NE0140001","Pediatric Dental B and Adult Dental E","45550NE014",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,"Adult annual plan maximum is $1000",,,,,"Allows Adult and Child-Only",,,,"$23.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Dental Only","Yes","Similar to In Service Area Coverage","Yes",,,,,"45550NE0140001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$1,000","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020005","BESTOne Dental Plus - Silver","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"50022NE0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","SHOP (Small Group)","Yes","95-6042390","50022NE0010006","BEST Dental Basic - Silver","50022NE001",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BEST_Dental_Basic_Plan_(Silver).pdf",,"50022NE0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","NE","50022","SERFF","6","2014-01-21 11:24:32","1","50022","NE","Individual","Yes","95-6042390","50022NE0020006","BESTOne Dental Basic - Silver","50022NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NE/pdf/NE_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"50022NE0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0020001","Guide HMO 25/50 1600/3200 10% 4000/8000 Rx2","77931NE002","7659374889","NEN001","NES001","NEF002","New","HMO","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/19X/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/19X/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0020001-01","Standard Gold On Exchange Plan","78.70%","0","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,600","$3,200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,600","$10","$400","$200","$600","$700","$60","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050002","Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3","77931NE005","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050002-01","Standard Silver On Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,400","$200","$1,500","$600","$200","$802","5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","4","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0080001","Guardian Family Essentials","24847NH008",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0080001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","2","57601","NH","Individual","Yes","02-0510530","57601NH0420001","Anthem Dental Family","57601NH042",,"NHN001","NHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.82",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155851.pdf",,,,"57601NH0420001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","2","57601","NH","Individual","Yes","02-0510530","57601NH0420052","Anthem Dental Family Enhanced","57601NH042",,"NHN001","NHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155894.pdf",,,,"57601NH0420052-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","2","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0390002","Anthem Dental Family Enhanced","57601NH039",,"NHN001","NHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155894.pdf",,,,"57601NH0390002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-05","87% AV Level Silver Plan","86.17%","0.861683309078217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,150","$2,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150001","Anthem Bronze DirectAccess w/HSA - cacc","96751NH015",,"NHN001","NHS001","NHF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAF","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150001-01","Standard Bronze On Exchange Plan","61.64%","0.621244966983795","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150001","Anthem Bronze DirectAccess w/HSA - cacc","96751NH015",,"NHN001","NHS001","NHF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAF","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","1","87701","NH","Individual","Yes","02-0273013","87701NH0070001","Delta Dental Family High Plan","87701NH007",,"NHN001","NHS001",,"New","EPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$38.30",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20141.pdf",,"87701NH0070001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0120001","Delta Dental EPO Family Low Plan","87701NH012",,"NHN001","NHS001",,"New","EPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$30.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20146.pdf",,"87701NH0120001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","4","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0080001","Guardian Family Essentials","24847NH008",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0080001-01","Standard Low On Exchange Plan","70.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NH","57601","SERFF","8","2014-03-20 11:33:30","1","57601","NH","SHOP (Small Group)","Yes","02-0510530","57601NH0370001","Anthem Dental Pediatric","57601NH037",,"NHN001","NHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$30.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","https://www.anthem.com/agent/nh/f4/s3/t0/pw_b155870.pdf",,,,"57601NH0370001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120002-01","Standard Gold On Exchange Plan","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","9"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","3%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$200","$200","$0","$800","$20","$80","17"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","5","77931","NE","Individual","No","37-1354502","77931NE0110002","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE011","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110002-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","4"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.995244753707683",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","19722NM0010003-01","Standard Bronze On Exchange Plan","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","4"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.995244753707683",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","19722NM0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","3","19722","NM","Individual","No","85-0408506","19722NM0010003","Molina Marketplace Bronze Plan","19722NM001",,"NMN001","NMS001","NMF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.995244753707683",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/bronze","19722NM0010003-03","Limited Cost Sharing Plan Variation","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","6"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0010001","Guardian Pediatric Advantage","98048NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0010001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0010001","Guardian Pediatric Advantage","98048NE001",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0010001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0020001","Guardian Pediatric Essentials","98048NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0020001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","1","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0020001","Guardian Pediatric Essentials","98048NE002",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0020001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0030001","Guardian Family Advantage Plus","98048NE003",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0030001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","2","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0030001","Guardian Family Advantage Plus","98048NE003",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0030001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120002","Pathfinder POS QHDHP 2100/4200 0% 2100/4200 RxDed","77931NE012","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I4J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I4J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120002-03","Limited Cost Sharing Plan Variation","78.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$12,500","$25,000","$14,600","$29,200",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,200","0%",,,,"$4,200","$8,400","$6,300","$12,600","$2,100","$0","$0","$200","$2,100","$0","$0","$80","11"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","12"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","13"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-03","Limited Cost Sharing Plan Variation","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","15"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-04","73% AV Level Silver Plan","72.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","16"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,500","$21,000","$12,200","$24,400",,,,,,,,,,,,,,,,,,,,,"$450","$900","15%",,,,"$3,500","$7,000","$3,950","$7,900","$450","$10","$800","$200","$450","$600","$200","$80","17"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0120003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx 2","77931NE012","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3T/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3T/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0120003-06","94% AV Level Silver Plan","93.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"$10,500","$21,000","$12,200","$24,400",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$10","$300","$200","$0","$600","$50","$80","18"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","19"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","20"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-03","Limited Cost Sharing Plan Variation","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","22"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-04","73% AV Level Silver Plan","72.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,700","$7,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$10","$900","$200","$1,750","$400","$100","$80","23"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$450","$900","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$400","$10","$800","$200","$400","$600","$200","$80","24"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110001","Guide HMO QHDHP 1750/3500 20% 5500/11000 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2S/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2S/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110001-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$10","$300","$200","$0","$600","$50","$80","25"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-00","Standard Silver Off Exchange Plan","68.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$10","$800","$200","$2,000","$500","$100","$80","26"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-01","Standard Silver On Exchange Plan","68.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$10","$800","$200","$2,000","$500","$100","$80","27"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","28"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-03","Limited Cost Sharing Plan Variation","68.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$10","$800","$200","$2,000","$500","$100","$80","29"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-04","73% AV Level Silver Plan","72.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$10","$800","$200","$2,000","$500","$100","$80","30"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-05","87% AV Level Silver Plan","86.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$10","$800","$200","$500","$500","$200","$80","31"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","1","77931","NE","Individual","No","37-1354502","77931NE0110004","Guide HMO QHDHP 2000/4000 20% 5250/10500 Rx2","77931NE011","7659374889","NEN001","NES001","NEF002","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/24L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/24L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110004-06","94% AV Level Silver Plan","93.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$10","$600","$200","$0","$600","$100","$80","32"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0020003","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE002","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/25E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/25E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0020003-00","Standard Silver Off Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$600","$800","$100","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","Individual","No","37-1354502","77931NE0090001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77931NE009","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090001-00","Standard Gold Off Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","Individual","No","37-1354502","77931NE0090001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77931NE009","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090001-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010002","Pathfinder POS 1750/3500 30% 5500/11000  Rx3","77931NE001","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QM/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QM/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010002-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","8"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,400","$6,800",,,"$11,500","$23,000","$14,900","$29,800","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","8"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010002","Pathfinder POS 1750/3500 30% 5500/11000  Rx3","77931NE001","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6QM/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6QM/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010002-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","9"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-05","87% AV Level Silver Plan","86.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,500","$23,000","$13,350","$26,700","$150","$300","25%",,,,"$3,500","$7,000","$3,650","$7,300","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$150","$20","$1,500","$200","$150","$700","$300","$80","9"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060004","Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NA/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NA/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060004-00","Standard Gold Off Exchange Plan","80.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$9,500","$19,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$0","$0","$200","$1,750","$0","$0","$80","10"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-06","94% AV Level Silver Plan","93.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"$11,500","$23,000","$13,350","$26,700","$0","$0","3%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$20","$300","$200","$0","$700","$50","$80","10"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060004","Pathfinder POS QHDHP 1750/3500 0% 1750/3500 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NA/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NA/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060004-01","Standard Gold On Exchange Plan","80.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,750","$3,500",,,"$9,500","$19,000","$11,250","$22,500",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$0","$0","$200","$1,750","$0","$0","$80","11"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2","77931NE006","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NU/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NU/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060003-00","Standard Silver Off Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","12"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060003","Pathfinder POS QHDHP 1750/3500 20% 5000/10000 Rx2","77931NE006","7659374889","NEN001","NES001","NEF002","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6NU/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6NU/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060003-01","Standard Silver On Exchange Plan","70.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,500","$21,000","$15,500","$31,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","20%",,,,"$3,500","$7,000","$5,250","$10,500","$1,750","$10","$900","$200","$1,750","$400","$100","$80","13"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UD/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UD/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060001-00","Standard Gold Off Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","14"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0060001","Pathfinder POS QHDHP 2000/4000 0% 2000/4000 RxDed","77931NE006","7659374889","NEN001","NES001","NEF004","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6UD/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6UD/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0060001-01","Standard Gold On Exchange Plan","78.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$11,000","$22,000","$13,000","$26,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","$6,000","$12,000","$2,000","$0","$0","$200","$2,000","$0","$0","$80","15"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0020003","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE002","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/25E/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/25E/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0020003-01","Standard Silver On Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$600","$800","$100","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050003","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE005","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050003-00","Standard Bronze Off Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","Individual","No","37-1354502","77931NE0090001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77931NE009","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$80","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050003","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE005","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/26J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/26J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","Individual","No","37-1354502","77931NE0090001","Pathfinder POS 20/40 1200/2400 20% 4000/8000 Rx2","77931NE009","7659374889","NEN001","NES001","NEF002","New","POS","Gold","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I3N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090001-03","Limited Cost Sharing Plan Variation","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$8,000","$16,000","$12,000","$24,000","$1,200","$2,400","20%",,,,"$2,400","$4,800","$3,600","$7,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,200","$10","$1,000","$200","$900","$600","$0","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","5","77931","NE","Individual","No","37-1354502","77931NE0110002","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE011","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110002-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","5"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","5","77931","NE","Individual","No","37-1354502","77931NE0110002","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE011","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","5","77931","NE","Individual","No","37-1354502","77931NE0110002","Guide HMO QHDHP 3150/6300 40% 6350/12700 Rx3","77931NE011","7659374889","NEN001","NES001","NEF003","New","HMO","Bronze","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I3J/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I3J/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110002-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,150","$6,300","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,150","$20","$1,100","$200","$3,150","$400","$70","$80","7"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","6","77931","NE","Individual","No","37-1354502","77931NE0110003","Guide HMO 6350/12700 0% 6350/12700 RxDed","77931NE011","7659374889","NEN001","NES001","NEF004","New","HMO","Catastrophic","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/27C/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/27C/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110003-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$5,100","$0","$0","$80","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","6","77931","NE","Individual","No","37-1354502","77931NE0110003","Guide HMO 6350/12700 0% 6350/12700 RxDed","77931NE011","7659374889","NEN001","NES001","NEF004","New","HMO","Catastrophic","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/27C/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/27C/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0110003-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$0","$0","$200","$5,100","$0","$0","$80","5"
"2014","NE","90142","SERFF","1","2013-08-13 21:01:26","1","90142","NE","SHOP (Small Group)","Yes","35-0472300","90142NE0010001","DentalConnect�","90142NE001",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"90142NE0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE001","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6MJ/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6MJ/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010003-00","Standard Silver Off Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$50",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","8"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","2","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0010003","Pathfinder POS 30/60 2400/4800 30% 5500/11000 Rx5","77931NE001","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/6MJ/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/6MJ/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0010003-01","Standard Silver On Exchange Plan","71.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,400","$4,800","30%",,,,"$4,800","$9,600","$7,200","$14,400","$250","$500","100%",,,,"$250","$500","$250","$50",,,,,,,,,,,"$2,400","$0","$1,100","$200","$1,800","$100","$0","$80","9"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","SHOP (Small Group)","No","37-1354502","77931NE0050002","Guide HMO QHDHP 1500/3000 30% 5250/10500 Rx3","77931NE005","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care",,"Yes","Yes","$0.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/21L/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/21L/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0050002-00","Standard Silver Off Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,250","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$20","$1,400","$200","$1,500","$600","$200","$802","4"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","3","77931","NE","Individual","No","37-1354502","77931NE0090002","Pathfinder POS 1750/3500 30% 5500/11000 Rx3","77931NE009","7659374889","NEN001","NES001","NEF003","New","POS","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Out of Network Coverage available","Yes","Out of Network Coverage available","No","https://plans.healthalliancemarket.org/I2Z/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2Z/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0090002-00","Standard Silver Off Exchange Plan","68.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,500","$23,000","$17,000","$34,000","$1,750","$3,500","30%",,,,"$3,500","$7,000","$5,250","$10,500","$0","$0","100%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,750","$20","$1,300","$200","$1,300","$700","$0","$80","4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","1","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0110001","Delta Dental EPO Family High Plan","87701NH011",,"NHN001","NHS001",,"New","EPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Adult and Child-Only",,,,"$38.30",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20145.pdf",,"87701NH0110001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","2","87701","NH","Individual","Yes","02-0273013","87701NH0090001","Delta Dental Pediatric High Plan","87701NH009",,"NHN001","NHS001",,"New","EPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$38.30",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20143.pdf",,"87701NH0090001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-00","Standard Silver Off Exchange Plan","70.97%","0.709696888923645","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-01","Standard Silver On Exchange Plan","70.97%","0.709696888923645","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids 1A","75605NM043",,"NMN004","NMS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430003-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370005","Blue Advantage Bronze HMO 005","75605NM037",,"NMN003","NMS003","NMF008","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370005-00","Standard Bronze Off Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","2","87701","NH","Individual","Yes","02-0273013","87701NH0100001","Delta Dental Pediatric Low Plan","87701NH010",,"NHN001","NHS001",,"New","EPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$30.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,"https://auth.deltadentalcoversme.com/sp/ACS.saml2","http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20144.pdf",,"87701NH0100001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","1","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160001","Anthem Gold Guided Access Plus-groa","96751NH016",,"NHN001","NHS001","NHF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.990825114754714",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/nh�����������������������","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/NHSelectdrugtier3","96751NH0160001-01","Standard Gold On Exchange Plan","79.86%","0.80267858505249","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","$500","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","2","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160002","Anthem Silver Guided Access Plus-gfpa","96751NH016",,"NHN001","NHS001","NHF001","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.988310959467191",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/nh�����������������������","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/NHSelectdrugtier3","96751NH0160002-01","Standard Silver On Exchange Plan","69.39%","0.683045864105225","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","2","96751","NH","Individual","No","02-0494919","96751NH0150005","Anthem Bronze DirectAccess w/Child Dental - cdaa","96751NH015",,"NHN002","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAK","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150005-01","Standard Bronze On Exchange Plan","59.80%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","2","96751","NH","Individual","No","02-0494919","96751NH0150005","Anthem Bronze DirectAccess w/Child Dental - cdaa","96751NH015",,"NHN002","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAK","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","2","96751","NH","Individual","No","02-0494919","96751NH0150005","Anthem Bronze DirectAccess w/Child Dental - cdaa","96751NH015",,"NHN002","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAK","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150005-03","Limited Cost Sharing Plan Variation","59.80%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","3","96751","NH","SHOP (Small Group)","No","02-0494919","96751NH0160003","Anthem Bronze Guided Access Plus-gjqa","96751NH016",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.986856961111492",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/nh�����������������������","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/NHSelectdrugtier3","96751NH0160003-01","Standard Bronze On Exchange Plan","58.72%","0","No","No","No","100%",,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","3","96751","NH","Individual","No","02-0494919","96751NH0150004","Anthem Bronze DirectAccess - caaa","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAJ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150004-01","Standard Bronze On Exchange Plan","59.80%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","3","96751","NH","Individual","No","02-0494919","96751NH0150004","Anthem Bronze DirectAccess - caaa","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAJ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","3","96751","NH","Individual","No","02-0494919","96751NH0150004","Anthem Bronze DirectAccess - caaa","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAJ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150004-03","Limited Cost Sharing Plan Variation","59.80%","0.668560802936554","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-00","Standard Silver Off Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$900","$800","$0","$80","11"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-01","Standard Silver On Exchange Plan","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$900","$800","$0","$80","12"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","13"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-03","Limited Cost Sharing Plan Variation","71.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$900","$800","$0","$80","14"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-04","73% AV Level Silver Plan","73.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$4,800","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,100","$200","$900","$800","$0","$80","15"
"2014","NE","77931","SERFF","6","2014-01-24 09:49:15","4","77931","NE","Individual","No","37-1354502","77931NE0070001","Guide HMO 30/60 2400/4800 30% 6000/12000 Rx3","77931NE007","7659374889","NEN001","NES001","NEF003","New","HMO","Silver","Yes","Both","No","Yes","All specialists (IN) may require a referral except OB-GYN and Optometrists","Acupunture, Custodial Care, Weight Loss Programs, Hearing Aids, Non Emergent Out of Network care","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Coverage Only","Yes","Emergency Coverage Only","No","https://plans.healthalliancemarket.org/I2N/012014/sbc.pdf","https://shop.healthalliancemarket.org/payment?source=ffe","https://plans.healthalliancemarket.org/I2N/012014/brochure.pdf","healthalliance.org/media/Health_Alliance_Comprehensive_Formulary_Public.pdf","77931NE0070001-05","87% AV Level Silver Plan","86.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,850","$3,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$20","$1,200","$200","$150","$800","$200","$80","16"
"2014","NE","90142","SERFF","1","2013-08-13 21:01:26","1","90142","NE","SHOP (Small Group)","Yes","35-0472300","90142NE0010002","DentalConnect�","90142NE001",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.81",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"90142NE0010002-00","Standard Low Off Exchange Plan","71.66%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","90142","SERFF","1","2013-08-13 21:01:26","2","90142","NE","SHOP (Small Group)","Yes","35-0472300","90142NE0010003","DentalConnect�","90142NE001",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"90142NE0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","95796","SERFF","1","2013-08-01 21:15:43","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0040002","EHB High PPO","95796NE004",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.32",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"95796NE0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","95796","SERFF","1","2013-08-01 21:15:43","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0040001","EHB Low PPO","95796NE004",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.92",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"95796NE0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","95796","SERFF","1","2013-08-01 21:15:43","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0030002","EHB High Passive","95796NE003",,"NEN001","NES001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$40.84",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"95796NE0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","95796","SERFF","1","2013-08-01 21:15:43","1","95796","NE","SHOP (Small Group)","Yes","93-0242990","95796NE0030001","EHB Low Passive","95796NE003",,"NEN001","NES001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.64",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"95796NE0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-04","73% AV Level Silver Plan","73.60%","0.733477354049683","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$920","$180","$80","7"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-05","87% AV Level Silver Plan","87.80%","0.877585172653198","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$680","$320","$80","8"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","3","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0050001","Guardian Family Essentials Plus","98048NE005",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0050001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","3","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0050001","Guardian Family Essentials Plus","98048NE005",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0050001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","4","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0040001","Guardian Family Advantage","98048NE004",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0040001-00","Standard High Off Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","4","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0040001","Guardian Family Advantage","98048NE004",,"NEN001","NES001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0040001-01","Standard High On Exchange Plan","84.60%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","4","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0060001","Guardian Family Essentials","98048NE006",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0060001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NE","98048","SERFF","2","2013-09-11 14:31:09","4","98048","NE","SHOP (Small Group)","Yes","13-5123390","98048NE0060001","Guardian Family Essentials","98048NE006",,"NEN001","NES001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"98048NE0060001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0090001","Guardian Pediatric Advantage","24847NH009",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0090001-00","Standard High Off Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0090001","Guardian Pediatric Advantage","24847NH009",,"NHN001","NHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0090001-01","Standard High On Exchange Plan","85.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0100001","Guardian Pediatric Essentials","24847NH010",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0100001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold $750 HMO","93091NM001",,"NMN002","NMS006","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$33.31","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-gold-$750-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-00","Standard Gold Off Exchange Plan","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,030","$0","$0","$750","$180","$110","$0","4"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold $750 HMO","93091NM001",,"NMN002","NMS006","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$33.31","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-gold-$750-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-01","Standard Gold On Exchange Plan","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,030","$0","$0","$750","$180","$110","$0","5"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold $750 HMO","93091NM001",,"NMN002","NMS006","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$33.31","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-gold-$750-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010001","Care Connect Gold $750 HMO","93091NM001",,"NMN002","NMS006","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$33.31","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-gold-$750-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010001-03","Limited Cost Sharing Plan Variation","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$1,030","$0","$0","$750","$180","$110","$0","7"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-00","Standard Silver Off Exchange Plan","70.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,525","$0","$0","$1,300","$375","$0","$0","8"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-01","Standard Silver On Exchange Plan","70.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,525","$0","$0","$1,300","$375","$0","$0","9"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-03","Limited Cost Sharing Plan Variation","70.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,525","$0","$0","$1,300","$375","$0","$0","11"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","3","57173","NM","Individual","No","94-3037165","57173NM0140003","Individual Bronze Plan C","57173NM014",,"NMN001","NMS001","NMF022","New","HMO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.981057153109053",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140003-00","Standard Bronze Off Exchange Plan","60.40%","0.603979647159576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","3","57173","NM","Individual","No","94-3037165","57173NM0140003","Individual Bronze Plan C","57173NM014",,"NMN001","NMS001","NMF022","New","HMO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.981057153109053",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140003-01","Standard Bronze On Exchange Plan","60.40%","0.603979647159576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NH","24847","SERFF","3","2013-09-16 08:58:26","1","24847","NH","SHOP (Small Group)","Yes","13-5123390","24847NH0100001","Guardian Pediatric Essentials","24847NH010",,"NHN001","NHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.17",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"24847NH0100001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","2","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0130001","Delta Dental EPO Pediatric High Plan","87701NH013",,"NHN001","NHS001",,"New","EPO","High",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$38.30",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20147.pdf",,"87701NH0130001-01","Standard High On Exchange Plan","86.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NH","87701","SERFF","3","2013-09-11 14:31:09","2","87701","NH","SHOP (Small Group)","Yes","02-0273013","87701NH0140001","Delta Dental EPO Pediatric Low Plan","87701NH014",,"NHN001","NHS001",,"New","EPO","Low",,"On the Exchange",,,,"Many covered services, including but not limited to oral evaluations, x-rays, cleanings, fluoride treatments, sealants, restorations, periodontal treatment and surgery, crowns, inlays, onlays, dentures, implants and root canal therapy, are subject to time and frequency limitations.  Covered services containing time and frequency limitations are available for more frequent treatment for pediatric enrollees with prior authorization.  Certain covered services, such as root canal therapy and sealants, apply to treatment for specified teeth, such as permanent teeth.  Certain procedures, such as post-operative visits following oral surgery, and cleanings performed on the same date by the same dentist as scaling and root planing, are considered a part of the complete treatment and not separately chargeable by the dentist.  Many dental repairs, replacements and retreatment are time limited and not separately chargeable by the dentist.  Fluoride treatment, sealants, tissue conditioning, and medically necessary orthodontia are covered services for pediatric enrollees only.  Other exclusions and limitations apply.  Please refer to your Policy for details.",,,,,"Allows Child-Only",,,,"$30.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage from National Delta Dental PPO Providers","Yes",,,"http://www.nedelta.com/SiteMedia/SiteResources/downloads/exchange/nh/oocnh20148.pdf",,"87701NH0140001-01","Standard Low On Exchange Plan","71.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$150","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","4","96751","NH","Individual","No","02-0494919","96751NH0150003","Anthem Bronze DirectAccess - cabr","96751NH015",,"NHN001","NHS001","NHF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAH","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150003-01","Standard Bronze On Exchange Plan","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","4","96751","NH","Individual","No","02-0494919","96751NH0150003","Anthem Bronze DirectAccess - cabr","96751NH015",,"NHN001","NHS001","NHF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAH","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","4","96751","NH","Individual","No","02-0494919","96751NH0150003","Anthem Bronze DirectAccess - cabr","96751NH015",,"NHN001","NHS001","NHF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAH","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150003-03","Limited Cost Sharing Plan Variation","61.95%","0.622591018676758","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150002","Anthem Bronze DirectAccess w/HSA - caax","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAG","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150002-01","Standard Bronze On Exchange Plan","60.96%","0.581748187541962","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150002","Anthem Bronze DirectAccess w/HSA - caax","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAG","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150002","Anthem Bronze DirectAccess w/HSA - caax","96751NH015",,"NHN001","NHS001","NHF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAG","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150002-03","Limited Cost Sharing Plan Variation","60.96%","0.581748187541962","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-01","Standard Silver On Exchange Plan","70.54%","0.70838850736618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-03","Limited Cost Sharing Plan Variation","70.54%","0.70838850736618","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","5","96751","NH","Individual","No","02-0494919","96751NH0150006","Anthem Silver DirectAccess w/HSA - cbdo","96751NH015",,"NHN001","NHS001","NHF006","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAR","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150006-04","73% AV Level Silver Plan","72.69%","0.727405488491058","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NH","96751","SERFF","14","2014-07-28 14:39:22","8","96751","NH","Individual","No","02-0494919","96751NH0150008","Anthem Silver DirectAccess - cbcm","96751NH015",,"NHN001","NHS001","NHF008","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency and Urgent Care only.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0SAZ","https://shop.bcbsga.com/sales/eox/payment/landing/nh","http://file.anthem.com/03264NHMENABS.pdf","www.anthem.com/NHSelectdrugtier4","96751NH0150008-06","94% AV Level Silver Plan","93.06%","0.925105810165405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0010001","Delta Dental Individual PPO, EHB Certified","17911NM001",,"NMN002","NMS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0010002","Delta Dental Individual PPO, EHB Certified","17911NM001",,"NMN002","NMS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0020001","Renaissance Individual Dental PPO, EHB Certified","17911NM002",,"NMN001","NMS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0020002","Renaissance Individual Dental PPO, EHB Certified","17911NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0060001","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$37.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.deltadentalnm.com/NM_EHB_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","www.deltadentalnm.com/NM_EHB_Plan_Brochure",,"17911NM0060001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","1","17911","NM","Individual","Yes","47-0397286","17911NM0060002","Delta Dental Individual PPO, EHB Certified (Exchange)","17911NM006",,"NMN002","NMS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.deltadentalnm.com/NM_EHB_Low","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","www.deltadentalnm.com/NM_EHB_Plan_Brochure",,"17911NM0060002-01","Standard Low On Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0070001","Delta Dental Individual Pediatric-Only PPO, EHB Certified","17911NM007",,"NMN002","NMS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$34.26",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0070001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0070002","Delta Dental Individual Pediatric-Only PPO, EHB Certified","17911NM007",,"NMN002","NMS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$28.18",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"17911NM0070002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","17911","SERFF","6","2013-11-27 09:24:34","2","17911","NM","Individual","Yes","47-0397286","17911NM0090001","Delta Dental Individual Pediatric-Only PPO, EHB Certified (Exchange)","17911NM009",,"NMN002","NMS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$37.22",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes","www.deltadentalnm.com/NM_Ped_High","https://psp.toolkitsonline.com/paymentWeb/saml/acs/post/alias/17911","www.deltadentalnm.com/NM_EHB_Plan_Brochure",,"17911NM0090001-01","Standard High On Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable",,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.996273335143344",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","19722NM0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","1","19722","NM","Individual","No","85-0408506","19722NM0010001","Molina Marketplace Gold Plan","19722NM001",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.996273335143344",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/gold","19722NM0010001-03","Limited Cost Sharing Plan Variation","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-01","Standard Silver On Exchange Plan","69.10%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","NM","19722","SERFF","4","2013-10-16 19:58:29","2","19722","NM","Individual","No","85-0408506","19722NM0010002","Molina Marketplace Silver Plan","19722NM001",,"NMN001","NMS001","NMF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.986948078719335",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/nm/en-us/hp/marketplace/plans/silver","19722NM0010002-03","Limited Cost Sharing Plan Variation","69.10%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","1","26075","NM","Individual","Yes","95-6042390","26075NM0020001","BESTOne Child Dental Plus","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Child_Denta_Plus_Plan.pdf",,"26075NM0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","1","26075","NM","Individual","Yes","95-6042390","26075NM0020001","BESTOne Child Dental Plus","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Child_Denta_Plus_Plan.pdf",,"26075NM0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","2","26075","NM","Individual","Yes","95-6042390","26075NM0020002","BESTOne Child Dental","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Child_Dental_Plan.pdf",,"26075NM0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","2","26075","NM","Individual","Yes","95-6042390","26075NM0020002","BESTOne Child Dental","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Child_Dental_Plan.pdf",,"26075NM0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-03","Limited Cost Sharing Plan Variation","71.64%","0.716368019580841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-04","73% AV Level Silver Plan","73.73%","0.737308740615845","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,150","$10,300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","3","26075","NM","Individual","Yes","95-6042390","26075NM0020004","BESTOne Dental Plus - Gold","26075NM002",,"NMN001","NMS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.12",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"26075NM0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","4","26075","NM","Individual","Yes","95-6042390","26075NM0020005","BESTOne Dental Plus - Silver","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"26075NM0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","4","26075","NM","Individual","Yes","95-6042390","26075NM0020005","BESTOne Dental Plus - Silver","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"26075NM0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140002","Individual Bronze Plan B","57173NM014",,"NMN001","NMS001","NMF021","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982027974012214",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140002","Individual Bronze Plan B","57173NM014",,"NMN001","NMS001","NMF021","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982027974012214",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140002-03","Limited Cost Sharing Plan Variation","61.49%","0.614887595176697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-05","87% AV Level Silver Plan","87.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$150","$300","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$150","$15","$2,220","$0","$150","$225","$345","$0","13"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-06","94% AV Level Silver Plan","94.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$100","$5","$0","$0","$100","$15","$0","$0","14"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","4","26075","NM","Individual","Yes","95-6042390","26075NM0020006","BESTOne Dental Basic - Silver","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"26075NM0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NM","26075","SERFF","5","2014-01-21 11:24:32","4","26075","NM","Individual","Yes","95-6042390","26075NM0020006","BESTOne Dental Basic - Silver","26075NM002",,"NMN001","NMS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.73",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at  Maximum Allowable Charge","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/NM/pdf/NM_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"26075NM0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0120002","Individual Gold Plan B","57173NM012",,"NMN001","NMS001","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.988433128889599",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120002-00","Standard Gold Off Exchange Plan","81.66%","0.816841840744019","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0120002","Individual Gold Plan B","57173NM012",,"NMN001","NMS001","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.988433128889599",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120002-01","Standard Gold On Exchange Plan","81.66%","0.816841840744019","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0120002","Individual Gold Plan B","57173NM012",,"NMN001","NMS001","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.988433128889599",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0120002","Individual Gold Plan B","57173NM012",,"NMN001","NMS001","NMF002","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.988433128889599",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120002-03","Limited Cost Sharing Plan Variation","81.66%","0.816841840744019","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-00","Standard Silver Off Exchange Plan","69.16%","0.692433893680573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-01","Standard Silver On Exchange Plan","69.16%","0.692433893680573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330002","Blue PPO Gold 002","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330002","Blue PPO Gold 002","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330001","Blue PPO Gold 001","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330002","Blue PPO Gold 002","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370002","Blue Advantage Gold HMO 002","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370002-00","Standard Gold Off Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370002","Blue Advantage Gold HMO 002","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120001","Individual Gold Plan A","57173NM012",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987825892641635",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120001-01","Standard Gold On Exchange Plan","81.45%","0.814495980739594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120001","Individual Gold Plan A","57173NM012",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987825892641635",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0150001","Individual Catastrophic Plan","57173NM015",,"NMN001","NMS001","NMF023","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.973570550017962",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0150001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120001","Individual Gold Plan A","57173NM012",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987825892641635",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120001-00","Standard Gold Off Exchange Plan","81.45%","0.814495980739594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-01","Standard Silver On Exchange Plan","70.96%","0.709630072116852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-03","Limited Cost Sharing Plan Variation","70.96%","0.709630072116852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-04","73% AV Level Silver Plan","73.75%","0.737468361854553","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-04","73% AV Level Silver Plan","73.03%","0.7303107380867","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-05","87% AV Level Silver Plan","87.38%","0.873809933662415","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-06","94% AV Level Silver Plan","93.11%","0.931100845336914","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370001","Blue Advantage Gold HMO 001","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-01","Standard Silver On Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","24"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","2","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550005","KP Gold 2000/15/HRA/$300 Contribution","20126OH055",,"OHN001","OHS001","OHF009","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Yes","$300.00","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550005-01","Standard Gold On Exchange Plan","78.50%","0.785101115703583","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$20","$900","$200","$100","$1,200","$0","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","2","20126","OH","Individual","No","34-0922268","20126OH0560004","KP Bronze 4500/50","20126OH056",,"OHN001","OHS002","OHF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560004-01","Standard Bronze On Exchange Plan","60.85%","0.608540594577789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,400","$20","$400","$200","$100","$2,000","$0","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550003","KP Gold 750/15","20126OH055",,"OHN001","OHS001","OHF009","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"4","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550003-01","Standard Gold On Exchange Plan","78.30%","0.782567381858826","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$1,000","$0","$200","$100","$1,200","$0","$40","6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560001","KP Gold 0/20","20126OH056",,"OHN001","OHS002","OHF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560001-03","Limited Cost Sharing Plan Variation","81.35%","0.81346607208252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,000","$200","$200","$0","$1,000","$40","$40","6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550004","KP Silver 2000/35","20126OH055",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550004-01","Standard Silver On Exchange Plan","70.60%","0.70640903711319","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$20","$1,300","$200","$100","$1,400","$0","$40","7"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560002","KP Gold 1000/20","20126OH056",,"OHN001","OHS002","OHF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560002-01","Standard Gold On Exchange Plan","78.40%","0.782468199729919","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$20","$1,100","$200","$100","$1,000","$0","$40","7"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-05","87% AV Level Silver Plan","87.14%","0.871420621871948","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-06","94% AV Level Silver Plan","94.67%","0.946682512760162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140001","Individual Bronze Plan A","57173NM014",,"NMN001","NMS001","NMF020","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982161760806168",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140001-00","Standard Bronze Off Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140001","Individual Bronze Plan A","57173NM014",,"NMN001","NMS001","NMF020","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982161760806168",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140001-01","Standard Bronze On Exchange Plan","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-03","Limited Cost Sharing Plan Variation","69.16%","0.692433893680573","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-04","73% AV Level Silver Plan","72.40%","0.724021911621094","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$75","$150","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-05","87% AV Level Silver Plan","86.73%","0.867306649684906","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$50","$100","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130001","Individual Silver Plan A","57173NM013",,"NMN001","NMS001","NMF004","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985736487311281",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130001-06","94% AV Level Silver Plan","94.67%","0.946682512760162","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0130005","Individual Silver Plan B","57173NM013",,"NMN001","NMS001","NMF008","New","HMO","Silver","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.985904293342913",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130005-00","Standard Silver Off Exchange Plan","70.96%","0.709630072116852","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140001","Individual Bronze Plan A","57173NM014",,"NMN001","NMS001","NMF020","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982161760806168",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140001","Individual Bronze Plan A","57173NM014",,"NMN001","NMS001","NMF020","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982161760806168",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140001-03","Limited Cost Sharing Plan Variation","61.58%","0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140002","Individual Bronze Plan B","57173NM014",,"NMN001","NMS001","NMF021","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982027974012214",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140002-00","Standard Bronze Off Exchange Plan","61.49%","0.614887595176697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","1","57173","NM","Individual","No","94-3037165","57173NM0140002","Individual Bronze Plan B","57173NM014",,"NMN001","NMS001","NMF021","New","HMO","Bronze","Yes","Both","No","No",,,"0","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.982027974012214",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140002-01","Standard Bronze On Exchange Plan","61.49%","0.614887595176697","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120001","Individual Gold Plan A","57173NM012",,"NMN001","NMS001","NMF001","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987825892641635",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120001-03","Limited Cost Sharing Plan Variation","81.45%","0.814495980739594","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120003","Individual Gold Plan C","57173NM012",,"NMN001","NMS001","NMF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987658694600662",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120003-00","Standard Gold Off Exchange Plan","81.47%","0.814687192440033","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120003","Individual Gold Plan C","57173NM012",,"NMN001","NMS001","NMF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987658694600662",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120003-01","Standard Gold On Exchange Plan","81.47%","0.814687192440033","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120003","Individual Gold Plan C","57173NM012",,"NMN001","NMS001","NMF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987658694600662",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0120003","Individual Gold Plan C","57173NM012",,"NMN001","NMS001","NMF003","New","HMO","Gold","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.987658694600662",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0120003-03","Limited Cost Sharing Plan Variation","81.47%","0.814687192440033","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-00","Standard Silver Off Exchange Plan","71.64%","0.716368019580841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-01","Standard Silver On Exchange Plan","71.64%","0.716368019580841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-05","87% AV Level Silver Plan","87.61%","0.876142084598541","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","2","57173","NM","Individual","No","94-3037165","57173NM0130013","Individual Silver Plan D","57173NM013",,"NMN001","NMS001","NMF016","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.983935619228795",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130013-06","94% AV Level Silver Plan","93.11%","0.931100904941559","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370006","Blue Advantage Bronze HMO 006","75605NM037",,"NMN003","NMS003","NMF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330006","Blue PPO Bronze 006","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-05","87% AV Level Silver Plan","87.57%","0.875661015510559","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-03","Limited Cost Sharing Plan Variation","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$30","$2,200","$0","$1,300","$390","$0","$0","11"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-04","73% AV Level Silver Plan","73.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$30","$1,650","$0","$1,300","$390","$0","$0","12"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","3","57173","NM","Individual","No","94-3037165","57173NM0140003","Individual Bronze Plan C","57173NM014",,"NMN001","NMS001","NMF022","New","HMO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.981057153109053",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","3","57173","NM","Individual","No","94-3037165","57173NM0140003","Individual Bronze Plan C","57173NM014",,"NMN001","NMS001","NMF022","New","HMO","Bronze","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.981057153109053",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0140003-03","Limited Cost Sharing Plan Variation","60.40%","0.603979647159576","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390001","Blue Community Gold HMO 001","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390001","Blue Community Gold HMO 001","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"27"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390001","Blue Community Gold HMO 001","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390002","Blue Community Gold HMO 002","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390002-01","Standard Gold On Exchange Plan","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390002","Blue Community Gold HMO 002","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"30"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390002","Blue Community Gold HMO 002","75605NM039",,"NMN002","NMS002","NMF005","New","HMO","Gold","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390003","Blue Community Silver HMO 003","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"33"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","57173","SERFF","9","2014-01-21 11:24:32","4","57173","NM","Individual","No","94-3037165","57173NM0130009","Individual Silver Plan C","57173NM013",,"NMN001","NMS001","NMF012","New","HMO","Silver","Yes","Both","No","No",,,"0","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes",,"0.984944899696096",,,"0","0","0","2014-01-01",,"Yes","Emergency, and Non-Emergency when prior authorization is obtained","Yes","Emergency, and Non-Emergency when prior authorization is obtained","No","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","https://www.phs.org/insurance-plans/all-about-health-care/coverage-connector/payment-information/Pages/default.aspx","https://www.phs.org/insurance-plans/our-plans/individual-and-family/Pages/individual-and-family.aspx","http://docs.phs.org/idc/groups/public/documents/communication/pel_00170261.pdf","57173NM0130009-03","Limited Cost Sharing Plan Variation","70.97%","0.709696888923645","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330001","Blue PPO Gold 001","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330001-00","Standard Gold Off Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental 1A","75605NM043",,"NMN004","NMS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370001","Blue Advantage Gold HMO 001","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330001","Blue PPO Gold 001","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330001-01","Standard Gold On Exchange Plan","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"$6,500","$19,500","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"$6,500","$19,500","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","Yes","36-1236610","75605NM0430001","BlueCare Dental 1A","75605NM043",,"NMN004","NMS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$41.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430001-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330001","Blue PPO Gold 001","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental 1B","75605NM043",,"NMN004","NMS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430002-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370001","Blue Advantage Gold HMO 001","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","Yes","36-1236610","75605NM0430002","BlueCare Dental 1B","75605NM043",,"NMN004","NMS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430002-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370001","Blue Advantage Gold HMO 001","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370001-03","Limited Cost Sharing Plan Variation","79.04%","0.790385127067566","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$9,750","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370002","Blue Advantage Gold HMO 002","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330002","Blue PPO Gold 002","75605NM033",,"NMN001","NMS001","NMF001","New","PPO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"$7,000","$21,000","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"$3,000","$9,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370002","Blue Advantage Gold HMO 002","75605NM037",,"NMN003","NMS003","NMF005","New","HMO","Gold","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370002-03","Limited Cost Sharing Plan Variation","79.95%","0.799542129039764","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$10,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$4,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-00","Standard Silver Off Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-01","Standard Silver On Exchange Plan","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-03","Limited Cost Sharing Plan Variation","70.11%","0.701050579547882","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable","$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330003","Blue PPO Silver 003","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330003-04","73% AV Level Silver Plan","73.02%","0.730194807052612","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,400",,,"$10,000","$20,800","Not Applicable","Not Applicable","$5,000","$10,400","0%",,,,"$10,000","$20,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370003","Blue Advantage Silver HMO 003","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370003-06","94% AV Level Silver Plan","94.72%","0.947184801101685","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090017","Silver 1300 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc917.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure917.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090017-00","Standard Silver Off Exchange Plan",,"0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$1,863","$30","$1,300","$0","$1,206","$80","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-00","Standard Silver Off Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","15"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550008","KP Silver 1500/25/HSA","20126OH055",,"OHN001","OHS001","OHF009","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550008-01","Standard Silver On Exchange Plan","68.30%","0.68306577205658","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,400","$20","$1,000","$200","$1,500","$900","$10","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-01","Standard Silver On Exchange Plan","68.90%","0.689034223556519","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,600","$20","$1,200","$200","$1,800","$700","$100","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-03","Limited Cost Sharing Plan Variation","68.90%","0.689034223556519","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,600","$20","$1,200","$200","$1,800","$700","$100","$40","6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550011","KP Bronze 4500/50/HSA","20126OH055",,"OHN001","OHS001","OHF012","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550011-01","Standard Bronze On Exchange Plan","59.50%","0.594740808010101","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,400","$20","$700","$200","$4,500","$400","$0","$40","7"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-04","73% AV Level Silver Plan","73.20%","0.73204243183136","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$20","$800","$200","$1,300","$600","$100","$40","7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370005","Blue Advantage Bronze HMO 005","75605NM037",,"NMN003","NMS003","NMF008","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370005-03","Limited Cost Sharing Plan Variation",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids 1B","75605NM043",,"NMN004","NMS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430004-01","Standard Low On Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-00","Standard Silver Off Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-01","Standard Silver On Exchange Plan","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-03","Limited Cost Sharing Plan Variation","70.73%","0.707918882369995","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,000","$9,000","20%",,,,"$6,000","$18,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$10,400","$20,800","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"$5,000","$15,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0370004","Blue Advantage Silver HMO 004","75605NM037",,"NMN003","NMS003","NMF006","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0330004","Blue PPO Silver 004","75605NM033",,"NMN001","NMS001","NMF003","New","PPO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"$3,000","$9,000","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"$1,000","$3,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-04","73% AV Level Silver Plan","73.18%","0.731811702251434","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$7,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-05","87% AV Level Silver Plan","86.77%","0.867652237415314","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","1","75605","NM","Individual","No","36-1236610","75605NM0390004","Blue Community Silver HMO 004","75605NM039",,"NMN002","NMS002","NMF006","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390004-06","94% AV Level Silver Plan","94.25%","0.942455112934113","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330005","Blue PPO Bronze 005","75605NM033",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330005-00","Standard Bronze Off Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370005","Blue Advantage Bronze HMO 005","75605NM037",,"NMN003","NMS003","NMF008","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","Yes","36-1236610","75605NM0430003","BlueCare Dental 4 Kids 1A","75605NM043",,"NMN004","NMS004",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430003-01","Standard High On Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330005","Blue PPO Bronze 005","75605NM033",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330005-01","Standard Bronze On Exchange Plan",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370005","Blue Advantage Bronze HMO 005","75605NM037",,"NMN003","NMS003","NMF008","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330005","Blue PPO Bronze 005","75605NM033",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-03","Limited Cost Sharing Plan Variation",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","26"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-04","73% AV Level Silver Plan",,"0.722603440284729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$570","$525","$80","27"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-06","94% AV Level Silver Plan",,"0.934562087059021","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","20%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$280","$30","$0","$500","$0","$80","62"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-00","Standard Silver Off Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","63"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060023","Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060023-00","Standard Bronze Off Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","64"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060023","Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060023-01","Standard Bronze On Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","65"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-03","Limited Cost Sharing Plan Variation","70.51%","0.708841383457184","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,750","$7,500","$3,750","$7,500","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","Yes","36-1236610","75605NM0430004","BlueCare Dental 4 Kids 1B","75605NM043",,"NMN004","NMS004",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.07",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes",,"http://www.bcbsnm.com/coverage/individual/on-exchange/dental/payment/","http://www.bcbsnm.com/coverage/individual/on-exchange/dental/",,"75605NM0430004-00","Standard Low Off Exchange Plan","68.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560007","KP Bronze 5000/30%/HSA","20126OH056",,"OHN001","OHS002","OHF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$200","$0","$0","$0","$40","11"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560007","KP Bronze 5000/30%/HSA","20126OH056",,"OHN001","OHS002","OHF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560007-03","Limited Cost Sharing Plan Variation","58.90%","0.588992476463318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,900","$20","$400","$200","$5,000","$100","$0","$40","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060040","Bronze 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc640.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure640.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060040-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090031","Bronze 3500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc931.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure931.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090031-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","24"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330005","Blue PPO Bronze 005","75605NM033",,"NMN001","NMS001","NMF002","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330005-03","Limited Cost Sharing Plan Variation",,"0.595279037952423","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"$12,500","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"$10,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370006","Blue Advantage Bronze HMO 006","75605NM037",,"NMN003","NMS003","NMF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-06","94% AV Level Silver Plan","93.02%","0.931501686573029","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$700","$1,400","$700","$1,400","$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","0%","$175","$350","30%","$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-01","Standard Silver On Exchange Plan","71.27%","0.716808676719666","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560002","KP Gold 1000/20","20126OH056",,"OHN001","OHS002","OHF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","8"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560002","KP Gold 1000/20","20126OH056",,"OHN001","OHS002","OHF005","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560002-03","Limited Cost Sharing Plan Variation","78.40%","0.782468199729919","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,900","$20","$1,100","$200","$100","$1,000","$0","$40","9"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-01","Standard Silver On Exchange Plan","70.55%","0.70549613237381","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,500","$200","$100","$1,300","$0","$40","10"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560001","KP Gold 0/20","20126OH056",,"OHN001","OHS002","OHF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560001-01","Standard Gold On Exchange Plan","81.35%","0.81346607208252","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,000","$200","$200","$0","$1,000","$40","$40","4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740006","Anthem Bronze DirectAccess - caaz","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCT","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740006-01","Standard Bronze On Exchange Plan","62.00%","0.630797326564789","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$16,650","$33,300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","20%","$5,550","$11,100","20%","$11,100","$22,200","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740006","Anthem Bronze DirectAccess - caaz","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCT","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"58"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-03","Limited Cost Sharing Plan Variation",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","59"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-04","73% AV Level Silver Plan",,"0.722603440284729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$570","$525","$80","60"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-05","87% AV Level Silver Plan",,"0.866210162639618","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$800","$1,600","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$20","$680","$30","$800","$570","$130","$80","61"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330006","Blue PPO Bronze 006","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330006","Blue PPO Bronze 006","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370006","Blue Advantage Bronze HMO 006","75605NM037",,"NMN003","NMS003","NMF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0370006","Blue Advantage Bronze HMO 006","75605NM037",,"NMN003","NMS003","NMF007","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0370006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330006","Blue PPO Bronze 006","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"$12,000","$25,400","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390005","Blue Community Bronze HMO 005","75605NM039",,"NMN002","NMS002","NMF008","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390005-01","Standard Bronze On Exchange Plan",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330010","Blue Security PPO 010","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330010-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0330010","Blue Security PPO 010","75605NM033",,"NMN001","NMS001","NMF004","New","PPO","Catastrophic","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","3","2014-01-01",,"Yes","This Plan does not cover any services and/or supplies provided to a Member outside the United States if the Member traveled to the location for the purposes of receiving medical services, supplies, or drugs.","Yes","When accessing care outside our service area, you will obtain care from healthcare Providers that have a contractual agreement (i.e., are �Participating Providers�) with the local Blue Cross and/or Blue Shield Licensee in that other geographic area (�Host Blue�). In some instances, you may obtain care from Non-Participating Providers.","Yes","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0330010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390005","Blue Community Bronze HMO 005","75605NM039",,"NMN002","NMS002","NMF008","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390005","Blue Community Bronze HMO 005","75605NM039",,"NMN002","NMS002","NMF008","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390005-03","Limited Cost Sharing Plan Variation",,"0.595126330852509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$12,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390006","Blue Community Bronze HMO 006","75605NM039",,"NMN002","NMS002","NMF007","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390006","Blue Community Bronze HMO 006","75605NM039",,"NMN002","NMS002","NMF007","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"16"
"2014","NM","75605","SERFF","9","2013-11-27 09:24:34","2","75605","NM","Individual","No","36-1236610","75605NM0390006","Blue Community Bronze HMO 006","75605NM039",,"NMN002","NMS002","NMF007","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9997",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.bcbsnm.com/coverage/individual/on-exchange/","https://retailweb.hcsc.net/retailshoppingcart2/NM/exchange_referred","http://www.bcbsnm.com/coverage/individual/on-exchange/","www.bcbsnm.com/member/rx_drugs.html","75605NM0390006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030001","Choice Connect Gold  $500 PPO","93091NM003",,"NMN002","NMS006","NMF001","New","PPO","Gold","Yes","Both","No","No",,,"$42.59","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-gold-$500-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030001-00","Standard Gold Off Exchange Plan","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$20","$2,110","$0","$500","$180","$240","$0","4"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030001","Choice Connect Gold  $500 PPO","93091NM003",,"NMN002","NMS006","NMF001","New","PPO","Gold","Yes","Both","No","No",,,"$42.59","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-gold-$500-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030001-01","Standard Gold On Exchange Plan","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$20","$2,110","$0","$500","$180","$240","$0","5"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030001","Choice Connect Gold  $500 PPO","93091NM003",,"NMN002","NMS006","NMF001","New","PPO","Gold","Yes","Both","No","No",,,"$42.59","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-gold-$500-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030001","Choice Connect Gold  $500 PPO","93091NM003",,"NMN002","NMS006","NMF001","New","PPO","Gold","Yes","Both","No","No",,,"$42.59","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,"$250","0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-gold-$500-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030001-03","Limited Cost Sharing Plan Variation","79.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$500","$20","$2,110","$0","$500","$180","$240","$0","7"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-00","Standard Silver Off Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$30","$2,200","$0","$1,300","$390","$0","$0","8"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-01","Standard Silver On Exchange Plan","70.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","40%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$2,000","$30","$2,200","$0","$1,300","$390","$0","$0","9"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","1","93091","NM","Individual","No","45-1294709","93091NM0030002","Choice Connect Silver $2,000 PPO","93091NM003",,"NMN002","NMS006","NMF003","New","PPO","Silver","Yes","Both","No","No",,,"$57.64","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Within USA","Yes","http://mynmhc.org/choice-connect-silver-$2-000-ppo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0030002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","10"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-04","73% AV Level Silver Plan","73.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,025","$0","$0","$1,300","$375","$0","$0","12"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-05","87% AV Level Silver Plan","87.40%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$315","$0","$0","$250","$225","$0","$0","13"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","2","93091","NM","Individual","No","45-1294709","93091NM0010002","Care Connect Silver $2,000 HMO","93091NM001",,"NMN002","NMS006","NMF003","New","HMO","Silver","Yes","Both","No","No",,,"$43.93","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-silver-$2-000-hmo.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010002-06","94% AV Level Silver Plan","93.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$80","$0","$0","$0","$15","$0","$0","14"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","3","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze HMO","93091NM001",,"NMN002","NMS006","NMF004","New","HMO","Bronze","Yes","Both","No","No",,,"$67.30","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-bronze.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-00","Standard Bronze Off Exchange Plan","60.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$2,520","$0","$2,500","$0","$1,450","$0","4"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","3","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze HMO","93091NM001",,"NMN002","NMS006","NMF004","New","HMO","Bronze","Yes","Both","No","No",,,"$67.30","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-bronze.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-01","Standard Bronze On Exchange Plan","60.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$2,520","$0","$2,500","$0","$1,450","$0","5"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","3","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze HMO","93091NM001",,"NMN002","NMS006","NMF004","New","HMO","Bronze","Yes","Both","No","No",,,"$67.30","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-bronze.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","6"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","3","93091","NM","Individual","No","45-1294709","93091NM0010006","Care Connect Bronze HMO","93091NM001",,"NMN002","NMS006","NMF004","New","HMO","Bronze","Yes","Both","No","No",,,"$67.30","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-bronze.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010006-03","Limited Cost Sharing Plan Variation","60.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$0","$2,520","$0","$2,500","$0","$1,450","$0","7"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","4","93091","NM","Individual","No","45-1294709","93091NM0010007","Care Connect Catastrophic HMO","93091NM001",,"NMN002","NMS006","NMF005","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,"Child-only policies excluded","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/care-connect-catastrophic.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0010007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$0","$5,000","$0","$0","$0","4"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-01","Standard Silver On Exchange Plan","69.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,525","$0","$0","$1,300","$375","$0","$0","4"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-03","Limited Cost Sharing Plan Variation","69.70%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,525","$0","$0","$1,300","$375","$0","$0","6"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-04","73% AV Level Silver Plan","73.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$2,025","$0","$0","$1,300","$375","$0","$0","7"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-05","87% AV Level Silver Plan","87.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$300","$600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$220","$0","$0","$300","$180","$0","$0","8"
"2014","NM","93091","SERFF","9","2014-03-18 09:48:59","5","93091","NM","Individual","No","45-1294709","93091NM0020001","UNM Care Connect $2,000","93091NM002",,"NMN001","NMS001","NMF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$50.74","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://mynmhc.org/unm-connect-$2000.pdf","https://enroll.mynmhc.org/ffmcheckout","http://www.mynmhc.org/Member_Handbook.aspx","http://www.mynmhc.org/Formulary.aspx","93091NM0020001-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$850","$1,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$25","$50","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$55","$0","$0","$25","$100","$0","$0","9"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-06","94% AV Level Silver Plan","93.10%","0.930821895599365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$10","$600","$200","$0","$400","$10","$40","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090043","Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc943.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure943.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090043-01","Standard Gold On Exchange Plan",,"0.815265119075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,398","$30","$500","$570","$850","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060046","Gold 1250","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060046-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-04","73% AV Level Silver Plan",,"0.722446024417877","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$480","$30","$3,870","$630","$0","$80","67"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-05","87% AV Level Silver Plan",,"0.863897502422333","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$20","$280","$30","$570","$630","$105","$80","68"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550001","KP Gold 0/20","20126OH055",,"OHN001","OHS001","OHF008","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"4","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550001-01","Standard Gold On Exchange Plan","79.40%","0.794353544712067","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$1,000","$200","$200","$0","$1,500","$40","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560001","KP Gold 0/20","20126OH056",,"OHN001","OHS002","OHF004","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550002","KP Gold 250/15","20126OH055",,"OHN001","OHS001","OHF009","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"4","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550002-01","Standard Gold On Exchange Plan","80.70%","0.806525647640228","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$300","$1,000","$80","$200","$100","$1,200","$0","$40","5"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","11"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-03","Limited Cost Sharing Plan Variation","70.55%","0.70549613237381","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,500","$200","$100","$1,300","$0","$40","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-06","94% AV Level Silver Plan",,"0.93430769443512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$250","$500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$20","$130","$30","$0","$400","$0","$80","69"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090049","Platinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc949.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure949.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090049-00","Standard Platinum Off Exchange Plan",,"0.88265722990036","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$0","$726","$30","$250","$0","$507","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060053","Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060053-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","37"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060053","Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060053-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","38"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060063","Bronze 3500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060063-03","Limited Cost Sharing Plan Variation",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","63"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060064","Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060064-00","Standard Bronze Off Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","64"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-04","73% AV Level Silver Plan","72.78%","0.732581913471222","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%","$2,500","$5,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-05","87% AV Level Silver Plan","86.13%","0.864477396011353","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,750","$3,500","$1,750","$3,500","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%","$750","$1,500","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-06","94% AV Level Silver Plan","93.10%","0.932903051376343","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$750","$1,500","$750","$1,500","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$225","$450","10%","$225","$450","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740016","Anthem Catastrophic DirectAccess","29276OH074",,"OHN001","OHS001","OHF001","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDV","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-01","Standard Silver On Exchange Plan","70.35%","0.709633886814117","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%","$2,500","$5,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-03","Limited Cost Sharing Plan Variation","70.35%","0.709633886814117","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%","$2,500","$5,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-04","73% AV Level Silver Plan","72.88%","0.73613303899765","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","10%","$2,000","$4,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-04","73% AV Level Silver Plan","73.30%","0.732877969741821","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,400","$20","$1,000","$200","$100","$1,300","$0","$40","13"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","1","20126","OH","Individual","No","34-0922268","20126OH0560003","KP Silver 1500/30","20126OH056",,"OHN001","OHS002","OHF006","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560003-05","87% AV Level Silver Plan","87.10%","0.871419131755829","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$20","$1,300","$200","$0","$1,100","$30","$40","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060046","Gold 1250","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060046-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090042","Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc942.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure942.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090042-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","14"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-04","73% AV Level Silver Plan","73.36%","0.7405886054039","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,700","$3,400","20%","$1,700","$3,400","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-05","87% AV Level Silver Plan","86.20%","0.864877641201019","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-06","94% AV Level Silver Plan","93.05%","0.932138860225677","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%","$200","$400","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","8","29276","OH","Individual","No","31-1440175","29276OH0740003","Anthem Bronze DirectAccess - cabt","29276OH074",,"OHN001","OHS001","OHF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCQ","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740003-01","Standard Bronze On Exchange Plan","61.98%","0.625333786010742","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,900","$25,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%","$4,300","$8,600","50%","$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","8","29276","OH","Individual","No","31-1440175","29276OH0740003","Anthem Bronze DirectAccess - cabt","29276OH074",,"OHN001","OHS001","OHF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCQ","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","8","29276","OH","Individual","No","31-1440175","29276OH0740003","Anthem Bronze DirectAccess - cabt","29276OH074",,"OHN001","OHS001","OHF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCQ","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740003-03","Limited Cost Sharing Plan Variation","61.98%","0.625333786010742","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$12,900","$25,800","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,300","$8,600","20%","$4,300","$8,600","50%","$8,600","$17,200","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","2","20126","OH","Individual","No","34-0922268","20126OH0560004","KP Bronze 4500/50","20126OH056",,"OHN001","OHS002","OHF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$200","$0","$0","$0","$40","5"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","2","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550006","KP Gold 2000/15/HRA/$650 Contribution","20126OH055",,"OHN001","OHS001","OHF009","New","HMO","Gold","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","Yes","$650.00","Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550006-01","Standard Gold On Exchange Plan","81.60%","0.816303670406342","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,900","$20","$900","$200","$100","$1,200","$0","$40","5"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","2","20126","OH","Individual","No","34-0922268","20126OH0560004","KP Bronze 4500/50","20126OH056",,"OHN001","OHS002","OHF001","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560004-03","Limited Cost Sharing Plan Variation","60.85%","0.608540594577789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,400","$20","$400","$200","$100","$2,000","$0","$40","6"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","3","20126","OH","SHOP (Small Group)","No","34-0922268","20126OH0550007","KP Bronze 4000/40","20126OH055",,"OHN001","OHS001","OHF011","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.994016586831291",,,"0","0","0","2014-01-01",,"Yes","Emergency care only","Yes","Emergency care only","No","http://info.kp.org/healthplans/ohio/smallbusiness/summary-benefits-coverage",,"https://businessnet.kaiserpermanente.org/health/plans/oh/plans/smallbusiness?contentid=/html/plans/oh/small/hmo.html","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0550007-01","Standard Bronze On Exchange Plan","61.80%","0.617643177509308","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,900","$20","$500","$200","$600","$1,400","$0","$40","4"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","3","20126","OH","Individual","No","34-0922268","20126OH0560005","KP Catastrophic 6350/0","20126OH056",,"OHN001","OHS002","OHF003","New","HMO","Catastrophic","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","3","3","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$7,200","$0","$0","$200","$5,300","$0","$0","$40","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-06","94% AV Level Silver Plan",,"0.934247076511383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$680","$20","$0","$30","$265","$435","$0","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-00","Standard Silver Off Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060031","Gold 1250 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060031-03","Limited Cost Sharing Plan Variation",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","48"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","49"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750005","Anthem Bronze DirectAccess Plus w/ HSA-glbf","29276OH075",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989378950810401",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750005-01","Standard Bronze On Exchange Plan","61.54%","0.617601156234741","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$19,050","$38,100","$25,400","$50,800",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%","$3,500","$7,000","40%","$10,500","$21,000","$14,000","$28,000",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750006","Anthem Bronze DirectAccess Plus w/ HSA-gmbf","29276OH075",,"OHN001","OHS001","OHF002","New","PPO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.989299975941744",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750006-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%","$5,500","$11,000","10%","$16,500","$33,000","$22,000","$44,000",,,,,,,,,"7"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740005","Anthem Bronze DirectAccess - cafd","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740005-01","Standard Bronze On Exchange Plan","61.98%","0.620070338249207","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$17,250","$34,500","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%","$5,750","$11,500","20%","$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750008","Anthem Silver DirectAccess Plus gmob","29276OH075",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.991294590966337",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750008-01","Standard Silver On Exchange Plan","71.74%","0.72264039516449","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$19,050","$38,100","$25,400","$50,800","$1,500","$3,000","20%","$1,500","$3,000","20%","$4,500","$9,000","$6,000","$12,000","$500","$1,000","25%","$500","$1,000","25%","Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740005","Anthem Bronze DirectAccess - cafd","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750009","Anthem Silver DirectAccess Plus gpob","29276OH075",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.991501794003847",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750009-01","Standard Silver On Exchange Plan","70.77%","0.711224853992462","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$19,050","$38,100","$25,400","$50,800","$2,000","$4,000","20%","$2,000","$4,000","20%","$6,000","$12,000","$8,000","$16,000","$0","$0","25%","$0","$0","25%","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740005","Anthem Bronze DirectAccess - cafd","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740005-03","Limited Cost Sharing Plan Variation","61.98%","0.620070338249207","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$17,250","$34,500","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,750","$11,500","20%","$5,750","$11,500","20%","$11,500","$23,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740002","Anthem Bronze DirectAccess - cabu","29276OH074",,"OHN001","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCP","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740002-01","Standard Bronze On Exchange Plan","60.25%","0.666822671890259","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740002","Anthem Bronze DirectAccess - cabu","29276OH074",,"OHN001","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCP","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740002","Anthem Bronze DirectAccess - cabu","29276OH074",,"OHN001","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCP","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740002-03","Limited Cost Sharing Plan Variation","60.25%","0.666822671890259","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-05","87% AV Level Silver Plan",,"0.866210162639618","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$800","$1,600","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$20","$680","$30","$800","$570","$130","$80","28"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060042","Silver 3000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc642.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure642.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060042-06","94% AV Level Silver Plan",,"0.934562087059021","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","20%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$280","$30","$0","$500","$0","$80","29"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060022","Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060022-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"70"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060036","Catastrophic","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc636.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure636.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060036-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable","$6,350","$0","$0","$30","$6,350","$0","$0","$80","80"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-05","87% AV Level Silver Plan","86.32%","0.8665412068367","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","10%","$750","$1,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-06","94% AV Level Silver Plan","93.23%","0.934393584728241","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%","$200","$400","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740013","Anthem Gold DirectAccess - ccac","29276OH074",,"OHN001","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740013-01","Standard Gold On Exchange Plan","78.37%","0.798047125339508","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%","$1,250","$2,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740013","Anthem Gold DirectAccess - ccac","29276OH074",,"OHN001","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740013-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740013","Anthem Gold DirectAccess - ccac","29276OH074",,"OHN001","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDS","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740013-03","Limited Cost Sharing Plan Variation","78.37%","0.798047125339508","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","10%","$1,250","$2,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-01","Standard Silver On Exchange Plan","70.38%","0.706827521324158","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%","$3,500","$7,000","30%","$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090042","Gold 750","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc942.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure942.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090042-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060022","Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060022-03","Limited Cost Sharing Plan Variation",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","71"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-05","87% AV Level Silver Plan","87.30%","0.872979044914246","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$60","$200","$100","$700","$100","$40","8"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560006","KP Silver 1750/25%/HSA","20126OH056",,"OHN001","OHS002","OHF007","New","HMO","Silver","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560006-06","94% AV Level Silver Plan","94.40%","0.940118134021759","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$10","$300","$200","$100","$400","$50","$40","9"
"2014","OH","20126","SERFF","6","2013-09-17 21:55:00","4","20126","OH","Individual","No","34-0922268","20126OH0560007","KP Bronze 5000/30%/HSA","20126OH056",,"OHN001","OHS002","OHF002","New","HMO","Bronze","Yes","On the Exchange","No","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Diabetes, Pain Management",,"0.986211707712139",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/ohio/individual/summary-benefits-coverage","https://kaiserpermanente.billerpayments.com/app/cust/ssospayauth?","http://individual-family.kaiserpermanente.org/healthinsurance/_old/health-plan-coverage-and-costs/ohio-health-plan-coverage-and-costs�","https://healthy.kaiserpermanente.org/health/care/!ut/p/c4/04_SB8K8xLLM9MSSzPy8xBz9CP3I5NS8ktQiq-T8stSi1BTd3NSUzGSwdLFuWn5RbmlOYlGlfjhIZ1FqOlBYP9LfwxNsUH5KamaKfmR4QICVlU-Qo6m7m2FUoH5Bbq5FuaOiIgCA1PX0/","20126OH0560007-01","Standard Bronze On Exchange Plan","58.90%","0.588992476463318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,900","$20","$400","$200","$5,000","$100","$0","$40","10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060049","Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060049-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090050","Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc950.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure950.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090050-00","Standard Platinum Off Exchange Plan",,"0.884455919265747","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$729","$30","$200","$540","$458","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090050","Platinum 200","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc950.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure950.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090050-01","Standard Platinum On Exchange Plan",,"0.884455919265747","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$729","$30","$200","$540","$458","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060049","Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060049-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090048","Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc948.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure948.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090048-00","Standard Platinum Off Exchange Plan",,"0.880419075489044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$780","$30","$500","$540","$260","$80","6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060049","Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060049-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090048","Platinum 500","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc948.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure948.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090048-01","Standard Platinum On Exchange Plan",,"0.880419075489044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$780","$30","$500","$540","$260","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060049","Gold 350","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc649.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure649.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060049-03","Limited Cost Sharing Plan Variation",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060048","Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060048-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090047","Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc947.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure947.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090047-00","Standard Platinum Off Exchange Plan",,"0.907914519309998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$30","$460","$540","$0","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060048","Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060048-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090047","Platinum 1000","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc947.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure947.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090047-01","Standard Platinum On Exchange Plan",,"0.907914519309998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$30","$460","$540","$0","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060048","Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060048-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090044","Gold 350","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc944.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure944.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090044-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090044","Gold 350","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc944.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure944.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090044-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060048","Gold 750","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc648.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure648.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060048-03","Limited Cost Sharing Plan Variation",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090043","Gold 500","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc943.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure943.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090043-00","Standard Gold Off Exchange Plan",,"0.815265119075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,398","$30","$500","$570","$850","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060046","Gold 1250","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060046-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060046","Gold 1250","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc646.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure646.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060046-03","Limited Cost Sharing Plan Variation",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090041","Gold 1250","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc941.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure941.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090041-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090041","Gold 1250","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc941.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure941.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090041-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090038","Silver 700","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc938.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure938.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090038-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090038","Silver 700","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc938.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure938.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090038-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-03","Limited Cost Sharing Plan Variation",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090036","Silver 2000 75","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc936.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure936.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090036-00","Standard Silver Off Exchange Plan",,"0.719536542892456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,373","$30","$2,000","$630","$673","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-04","73% AV Level Silver Plan",,"0.739934027194977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060045","Silver 700","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc645.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure645.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060045-05","87% AV Level Silver Plan",,"0.861903011798859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$680","$30","$700","$660","$40","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090036","Silver 2000 75","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc936.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure936.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090036-01","Standard Silver On Exchange Plan",,"0.719536542892456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,373","$30","$2,000","$630","$673","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-00","Standard Silver Off Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","30"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-01","Standard Silver On Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","31"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-03","Limited Cost Sharing Plan Variation",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","33"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-04","73% AV Level Silver Plan",,"0.722446024417877","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$480","$30","$3,870","$630","$0","$80","34"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-05","87% AV Level Silver Plan",,"0.863897502422333","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$20","$280","$30","$570","$630","$105","$80","35"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060041","Silver 5000","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc641.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure641.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060041-06","94% AV Level Silver Plan",,"0.93430769443512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$250","$500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$20","$130","$30","$0","$400","$0","$80","36"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060034","Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060034-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","37"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060034","Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060034-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","38"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060034","Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060034-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060034","Gold 350 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc634.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure634.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060034-03","Limited Cost Sharing Plan Variation",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","40"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060033","Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060033-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","41"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060033","Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060033-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","42"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060033","Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060033-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060033","Gold 750 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc633.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure633.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060033-03","Limited Cost Sharing Plan Variation",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","44"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060031","Gold 1250 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060031-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","45"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060031","Gold 1250 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060031-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","46"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060031","Gold 1250 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc631.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure631.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060031-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","50"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"51"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-03","Limited Cost Sharing Plan Variation",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","52"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-04","73% AV Level Silver Plan",,"0.739934027194977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","53"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-05","87% AV Level Silver Plan",,"0.861903011798859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$680","$30","$700","$660","$40","$80","54"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060030","Silver 700 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc630.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure630.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060030-06","94% AV Level Silver Plan",,"0.934247076511383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$680","$20","$0","$30","$265","$435","$0","$80","55"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-00","Standard Silver Off Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","56"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060027","Silver 3000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc627.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure627.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060027-01","Standard Silver On Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","57"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-01","Standard Silver On Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","64"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"65"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-03","Limited Cost Sharing Plan Variation",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","66"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-04","73% AV Level Silver Plan",,"0.722446024417877","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$480","$30","$3,870","$630","$0","$80","67"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","1","28162","OH","Individual","No","34-1624818","28162OH0060026","Silver 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc626.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure626.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060026-05","87% AV Level Silver Plan",,"0.863897502422333","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$20","$280","$30","$570","$630","$105","$80","68"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090049","Platinum 250","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc949.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure949.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090049-01","Standard Platinum On Exchange Plan",,"0.88265722990036","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$0","$726","$30","$250","$0","$507","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090046","Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc946.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure946.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090046-00","Standard Platinum Off Exchange Plan",,"0.896662473678589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$1,500","$0","$0","$80","6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090046","Platinum 1500 Health Savings 500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc946.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure946.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090046-01","Standard Platinum On Exchange Plan",,"0.896662473678589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$1,500","$0","$0","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-00","Standard Silver Off Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-01","Standard Silver On Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090040","Gold 1300","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc940.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure940.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090040-00","Standard Gold Off Exchange Plan",,"0.796123325824738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$621","$30","$1,300","$0","$402","$80","10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-03","Limited Cost Sharing Plan Variation",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090040","Gold 1300","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc940.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure940.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090040-01","Standard Gold On Exchange Plan",,"0.796123325824738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$621","$30","$1,300","$0","$402","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-04","73% AV Level Silver Plan",,"0.721861779689789","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060044","Silver 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc644.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure644.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060044-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090037","Silver 1300","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc937.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure937.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090037-00","Standard Silver Off Exchange Plan",,"0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$1,863","$30","$1,300","$0","$1,206","$80","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-00","Standard Silver Off Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090037","Silver 1300","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc937.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure937.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090037-01","Standard Silver On Exchange Plan",,"0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$1,863","$30","$1,300","$0","$1,206","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090035","Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc935.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure935.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090035-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$0","$1,102","$30","$2,000","$0","$664","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-01","Standard Silver On Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090035","Silver 2000 80","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc935.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure935.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090035-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$0","$1,102","$30","$2,000","$0","$664","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-03","Limited Cost Sharing Plan Variation",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-04","73% AV Level Silver Plan",,"0.724138915538788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090033","Bronze 2500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc933.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure933.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090033-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090033","Bronze 2500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc933.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure933.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090033-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060043","Silver 1500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc643.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure643.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060043-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090032","Bronze 3000","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc932.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure932.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090032-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$0","$2,255","$30","$3,000","$0","$1,160","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060040","Bronze 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc640.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure640.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060040-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060040","Bronze 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc640.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure640.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060040-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090032","Bronze 3000","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc932.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure932.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090032-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$0","$2,255","$30","$3,000","$0","$1,160","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060040","Bronze 2500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc640.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure640.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060040-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","25"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090031","Bronze 3500","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc931.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure931.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090031-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","25"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060039","Bronze 3500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060039-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","26"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060039","Bronze 3500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060039-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","27"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060039","Bronze 3500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060039-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060039","Bronze 3500","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc639.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure639.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060039-03","Limited Cost Sharing Plan Variation",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","29"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060038","Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060038-00","Standard Bronze Off Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","30"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060038","Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060038-01","Standard Bronze On Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","31"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060038","Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060038-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060038","Bronze 5000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc638.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure638.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060038-03","Limited Cost Sharing Plan Variation",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","33"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060037","Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060037-00","Standard Bronze Off Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","34"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060037","Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060037-01","Standard Bronze On Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","35"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060037","Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060037-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"36"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060037","Bronze 6000","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc637.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure637.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060037-03","Limited Cost Sharing Plan Variation",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","37"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-00","Standard Silver Off Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","42"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-01","Standard Silver On Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","43"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"44"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-03","Limited Cost Sharing Plan Variation",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","45"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-04","73% AV Level Silver Plan",,"0.721861779689789","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","46"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","47"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060029","Silver 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc629.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure629.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060029-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","48"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-00","Standard Silver Off Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","49"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-01","Standard Silver On Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","50"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"51"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-03","Limited Cost Sharing Plan Variation",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","52"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-04","73% AV Level Silver Plan",,"0.724138915538788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","53"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","54"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060028","Silver 1500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc628.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure628.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060028-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","55"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060025","Bronze 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc625.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure625.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060025-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","56"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060025","Bronze 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc625.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure625.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060025-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","57"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060025","Bronze 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc625.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure625.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"58"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060025","Bronze 2500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc625.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure625.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060025-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","59"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060024","Bronze 3500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060024-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","60"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060024","Bronze 3500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060024-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","61"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060024","Bronze 3500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060024-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060024","Bronze 3500 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc624.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure624.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060024-03","Limited Cost Sharing Plan Variation",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","63"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060023","Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"66"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060023","Bronze 5000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc623.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure623.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060023-03","Limited Cost Sharing Plan Variation",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","67"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060022","Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060022-00","Standard Bronze Off Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","68"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060022","Bronze 6000 Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc622.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure622.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060022-01","Standard Bronze On Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","69"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","2","28162","OH","Individual","No","34-1624818","28162OH0060021","Catastrophic Select","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc621.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure621.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060021-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable","$6,350","$0","$0","$30","$6,350","$0","$0","$80","81"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060019","Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060019-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090030","Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc930.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure930.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090030-00","Standard Platinum Off Exchange Plan",,"0.884455919265747","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$729","$30","$200","$540","$458","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090030","Platinum 200 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc930.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure930.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090030-01","Standard Platinum On Exchange Plan",,"0.884455919265747","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","10%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$729","$30","$200","$540","$458","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060019","Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060019-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060019","Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060019-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090028","Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc928.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure928.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090028-00","Standard Platinum Off Exchange Plan",,"0.880419075489044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$780","$30","$500","$540","$260","$80","6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090028","Platinum 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc928.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure928.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090028-01","Standard Platinum On Exchange Plan",,"0.880419075489044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,300","$2,600",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$780","$30","$500","$540","$260","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060019","Gold 350 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc619.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure619.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060019-03","Limited Cost Sharing Plan Variation",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090027","Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc927.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure927.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090027-00","Standard Platinum Off Exchange Plan",,"0.907914519309998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$30","$460","$540","$0","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060018","Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060018-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090027","Platinum 1000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc927.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure927.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090027-01","Standard Platinum On Exchange Plan",,"0.907914519309998","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$0","$0","$30","$460","$540","$0","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060018","Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060018-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090024","Gold 350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc924.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure924.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090024-00","Standard Gold Off Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060018","Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060018-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090024","Gold 350 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc924.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure924.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090024-01","Standard Gold On Exchange Plan",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060018","Gold 750 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc618.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure618.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060018-03","Limited Cost Sharing Plan Variation",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090023","Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc923.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure923.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090023-00","Standard Gold Off Exchange Plan",,"0.815265119075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,398","$30","$500","$570","$850","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060016","Gold 1250 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060016-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060016","Gold 1250 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060016-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090023","Gold 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc923.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure923.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090023-01","Standard Gold On Exchange Plan",,"0.815265119075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$20","$1,398","$30","$500","$570","$850","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060016","Gold 1250 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090022","Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc922.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure922.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090022-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090022","Gold 750 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc922.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure922.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090022-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060016","Gold 1250 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc616.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure616.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060016-03","Limited Cost Sharing Plan Variation",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090021","Gold 1250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc921.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure921.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090021-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090021","Gold 1250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Gold","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc921.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure921.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090021-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090018","Silver 700 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc918.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure918.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090018-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090018","Silver 700 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc918.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure918.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090018-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-03","Limited Cost Sharing Plan Variation",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090016","Silver 2000 75 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc916.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure916.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090016-00","Standard Silver Off Exchange Plan",,"0.719536542892456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,373","$30","$2,000","$630","$673","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-04","73% AV Level Silver Plan",,"0.739934027194977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090016","Silver 2000 75 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF001","New","PPO","Silver","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc916.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure916.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0090016-01","Standard Silver On Exchange Plan",,"0.719536542892456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$20","$1,373","$30","$2,000","$630","$673","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-05","87% AV Level Silver Plan",,"0.861903011798859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$680","$30","$700","$660","$40","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060015","Silver 700 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc615.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure615.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060015-06","94% AV Level Silver Plan",,"0.934247076511383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$680","$20","$0","$30","$265","$435","$0","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-00","Standard Silver Off Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-01","Standard Silver On Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","24"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-03","Limited Cost Sharing Plan Variation",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","26"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-04","73% AV Level Silver Plan",,"0.722603440284729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$570","$525","$80","27"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-05","87% AV Level Silver Plan",,"0.866210162639618","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$800","$1,600","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$20","$680","$30","$800","$570","$130","$80","28"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060012","Silver 3000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc612.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure612.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060012-06","94% AV Level Silver Plan",,"0.934562087059021","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","20%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$280","$30","$0","$500","$0","$80","29"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-00","Standard Silver Off Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","30"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-01","Standard Silver On Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","31"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-03","Limited Cost Sharing Plan Variation",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","33"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-04","73% AV Level Silver Plan",,"0.722446024417877","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$4,000","$8,000","20%",,,,"$12,000","$24,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$4,000","$20","$480","$30","$3,870","$630","$0","$80","34"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-05","87% AV Level Silver Plan",,"0.863897502422333","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$2,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"$2,700","$5,400","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$900","$20","$280","$30","$570","$630","$105","$80","35"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060011","Silver 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc611.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure611.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060011-06","94% AV Level Silver Plan",,"0.93430769443512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$250","$500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$20","$130","$30","$0","$400","$0","$80","36"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060053","Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060053-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"39"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060053","Gold 350 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc653.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure653.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060053-03","Limited Cost Sharing Plan Variation",,"0.781130790710449","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$350","$700","25%",,,,"$1,050","$2,100","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$350","$20","$1,785","$30","$350","$570","$1,100","$80","40"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060054","Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060054-00","Standard Gold Off Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","41"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060054","Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060054-01","Standard Gold On Exchange Plan",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","42"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060054","Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060054-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"43"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060054","Gold 750 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc654.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure654.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060054-03","Limited Cost Sharing Plan Variation",,"0.780737996101379","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$2,250","$4,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$750","$20","$1,348","$30","$750","$540","$806","$80","44"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060056","Gold 1250 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060056-00","Standard Gold Off Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$540","$353","$80","45"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060056","Gold 1250 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060056-01","Standard Gold On Exchange Plan",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","46"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060056","Gold 1250 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060056-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"47"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060056","Gold 1250 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc656.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure656.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060056-03","Limited Cost Sharing Plan Variation",,"0.781455159187317","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$1,250","$2,500","10%",,,,"$3,750","$7,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$1,250","$20","$624","$30","$1,250","$660","$353","$80","48"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-00","Standard Silver Off Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","49"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-01","Standard Silver On Exchange Plan",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","50"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"51"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-03","Limited Cost Sharing Plan Variation",,"0.719911873340607","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","52"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-04","73% AV Level Silver Plan",,"0.739934027194977","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,169","$10,338",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$3,395","$30","$700","$660","$1,980","$80","53"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-05","87% AV Level Silver Plan",,"0.861903011798859","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","50%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$700","$20","$680","$30","$700","$660","$40","$80","54"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060057","Silver 700 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc657.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure657.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060057-06","94% AV Level Silver Plan",,"0.934247076511383","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$700","$1,400","0%",,,,"$2,100","$4,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$680","$20","$0","$30","$265","$435","$0","$80","55"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-00","Standard Silver Off Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","56"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-01","Standard Silver On Exchange Plan",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","57"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"58"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-03","Limited Cost Sharing Plan Variation",,"0.699551582336426","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$600","$516","$80","59"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-04","73% AV Level Silver Plan",,"0.722603440284729","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$19,050","$38,100","Not Applicable","Not Applicable","$3,000","$6,000","30%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$3,000","$20","$1,347","$30","$3,000","$570","$525","$80","60"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-05","87% AV Level Silver Plan",,"0.866210162639618","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$800","$1,600","20%",,,,"$2,400","$4,800","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$800","$20","$680","$30","$800","$570","$130","$80","61"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060060","Silver 3000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc660.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure660.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060060-06","94% AV Level Silver Plan",,"0.934562087059021","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable","$200","$400","20%",,,,"$600","$1,200","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$200","$20","$280","$30","$0","$500","$0","$80","62"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-00","Standard Silver Off Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","63"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-01","Standard Silver On Exchange Plan",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","64"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"65"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-03","Limited Cost Sharing Plan Variation",,"0.681439697742462","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$5,000","$20","$996","$30","$4,690","$630","$0","$80","66"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","3","28162","OH","Individual","No","34-1624818","28162OH0060061","Silver 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc661.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure661.pdf","http://www.AultCAS.com/acformularya.aspx","28162OH0060061-06","94% AV Level Silver Plan",,"0.93430769443512","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"$19,050","$38,100","Not Applicable","Not Applicable","$250","$500","20%",,,,"$750","$1,500","Not Applicable","Not Applicable","$0","$0","50%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$20","$130","$30","$0","$400","$0","$80","69"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090029","Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc929.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure929.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090029-00","Standard Platinum Off Exchange Plan",,"0.88265722990036","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$0","$726","$30","$250","$0","$507","$80","4"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090029","Platinum 250 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc929.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure929.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090029-01","Standard Platinum On Exchange Plan",,"0.88265722990036","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","10%",,,,"$750","$1,500","Not Applicable","Not Applicable","$250","$0","$726","$30","$250","$0","$507","$80","5"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090026","Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc926.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure926.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090026-00","Standard Platinum Off Exchange Plan",,"0.896662473678589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$1,500","$0","$0","$80","6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090026","Platinum 1500 Health Savings 500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Platinum","No","Both","No","No",,,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc926.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure926.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090026-01","Standard Platinum On Exchange Plan",,"0.896662473678589","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","0%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$0","$30","$1,500","$0","$0","$80","7"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-00","Standard Silver Off Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","8"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-01","Standard Silver On Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","9"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090020","Gold 1300 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc920.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure920.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090020-00","Standard Gold Off Exchange Plan",,"0.796123325824738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$621","$30","$1,300","$0","$402","$80","10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090020","Gold 1300 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc920.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure920.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090020-01","Standard Gold On Exchange Plan",,"0.796123325824738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$621","$30","$1,300","$0","$402","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-03","Limited Cost Sharing Plan Variation",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","11"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-04","73% AV Level Silver Plan",,"0.721861779689789","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","12"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","13"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060014","Silver 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc614.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure614.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060014-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","14"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090017","Silver 1300 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc917.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure917.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090017-01","Standard Silver On Exchange Plan",,"0.693472266197205","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","30%",,,,"$3,900","$7,800","Not Applicable","Not Applicable","$1,300","$0","$1,863","$30","$1,300","$0","$1,206","$80","15"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-01","Standard Silver On Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090015","Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc915.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure915.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090015-00","Standard Silver Off Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$0","$1,102","$30","$2,000","$0","$664","$80","16"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090015","Silver 2000 80 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Silver","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc915.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure915.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090015-01","Standard Silver On Exchange Plan",,"0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable","$2,000","$0","$1,102","$30","$2,000","$0","$664","$80","17"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-03","Limited Cost Sharing Plan Variation",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","18"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-04","73% AV Level Silver Plan",,"0.724138915538788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","19"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090013","Bronze 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc913.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure913.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090013-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","20"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090013","Bronze 2500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc913.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure913.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090013-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060013","Silver 1500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc613.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure613.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060013-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","21"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090012","Bronze 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc912.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure912.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090012-00","Standard Bronze Off Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$0","$2,255","$30","$3,000","$0","$1,160","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-00","Standard Silver Off Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","49"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-01","Standard Silver On Exchange Plan",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","50"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740004","Anthem Bronze DirectAccess - caah","29276OH074",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCR","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740004","Anthem Bronze DirectAccess - caah","29276OH074",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCR","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740004-03","Limited Cost Sharing Plan Variation","61.98%","0.63432902097702","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%","$6,000","$12,000","40%","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-01","Standard Silver On Exchange Plan","70.57%","0.71607631444931","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%","$2,500","$5,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-03","Limited Cost Sharing Plan Variation","70.57%","0.71607631444931","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%","$2,500","$5,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740011","Anthem Silver DirectAccess - cbpa","29276OH074",,"OHN001","OHS001","OHF013","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDD","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740011-04","73% AV Level Silver Plan","72.64%","0.735183238983154","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,750","$9,500","$4,750","$9,500","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","10%","$2,250","$4,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-03","Limited Cost Sharing Plan Variation","70.38%","0.706827521324158","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%","$3,500","$7,000","30%","$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-04","73% AV Level Silver Plan","72.43%","0.727333247661591","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%","$3,000","$6,000","30%","$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740009","Anthem Silver DirectAccess - cbai","29276OH074",,"OHN001","OHS001","OHF009","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD5","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740009-05","87% AV Level Silver Plan","86.12%","0.863081574440002","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,550","$3,100","$1,550","$3,100","$10,500","$21,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$850","$1,700","0%","$850","$1,700","30%","$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","7","29276","OH","Individual","No","31-1440175","29276OH0740010","Anthem Silver DirectAccess - cbce","29276OH074",,"OHN001","OHS001","OHF012","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD9","https://shop.anthem.com/sales/eox/payment/landing/oh",,"www.anthem.com/OHSelectdrugtier4","29276OH0740010-03","Limited Cost Sharing Plan Variation","71.27%","0.716808676719666","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","50%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060010","Bronze 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc610.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure610.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060010-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","22"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090012","Bronze 3000 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc912.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure912.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090012-01","Standard Bronze On Exchange Plan",,"0.606329083442688","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","50%",,,,"$9,000","$18,000","Not Applicable","Not Applicable","$3,000","$0","$2,255","$30","$3,000","$0","$1,160","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060010","Bronze 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc610.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure610.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060010-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","23"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060010","Bronze 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc610.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure610.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090011","Bronze 3500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc911.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure911.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090011-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","24"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060010","Bronze 2500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc610.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure610.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060010-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","25"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","SHOP (Small Group)","No","34-1624818","28162OH0090011","Bronze 3500 No Pediatric Dental","28162OH009","7376546504","OHN001","OHS002","OHF002","New","PPO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc911.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure911.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0090011-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","25"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060009","Bronze 3500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060009-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","26"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060009","Bronze 3500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060009-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","27"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060009","Bronze 3500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"28"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060009","Bronze 3500 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc609.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure609.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060009-03","Limited Cost Sharing Plan Variation",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","29"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060008","Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060008-00","Standard Bronze Off Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","30"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060008","Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060008-01","Standard Bronze On Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","31"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060008","Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"32"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060008","Bronze 5000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc608.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure608.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060008-03","Limited Cost Sharing Plan Variation",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","33"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060007","Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060007-00","Standard Bronze Off Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","34"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060007","Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060007-01","Standard Bronze On Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","35"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060007","Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"36"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060007","Bronze 6000 No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc607.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure607.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060007-03","Limited Cost Sharing Plan Variation",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","37"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-00","Standard Silver Off Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","42"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-01","Standard Silver On Exchange Plan",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","43"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"44"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-03","Limited Cost Sharing Plan Variation",,"0.694309234619141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","45"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-04","73% AV Level Silver Plan",,"0.721861779689789","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,200","$6,400",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$501","$30","$2,500","$0","$282","$80","46"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","47"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060058","Silver 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc658.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure658.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060058-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","48"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"51"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-03","Limited Cost Sharing Plan Variation",,"0.682375550270081","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","52"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-04","73% AV Level Silver Plan",,"0.724138915538788","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"$4,500","$9,000","Not Applicable","Not Applicable","$1,500","$0","$1,803","$30","$1,500","$0","$1,146","$80","53"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$3,300","$6,600","Not Applicable","Not Applicable","$1,100","$0","$0","$30","$1,100","$0","$0","$80","54"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060059","Silver 1500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Silver","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc659.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure659.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060059-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$500","$0","$0","$30","$500","$0","$0","$80","55"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060062","Bronze 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc662.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure662.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060062-00","Standard Bronze Off Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","56"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060062","Bronze 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc662.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure662.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060062-01","Standard Bronze On Exchange Plan",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","57"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060062","Bronze 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc662.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure662.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060062-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"58"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060062","Bronze 2500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc662.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure662.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060062-03","Limited Cost Sharing Plan Variation",,"0.615817248821259","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"$7,500","$15,000","Not Applicable","Not Applicable","$2,500","$0","$2,505","$30","$2,500","$0","$1,410","$80","59"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060063","Bronze 3500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060063-00","Standard Bronze Off Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","60"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060063","Bronze 3500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060063-01","Standard Bronze On Exchange Plan",,"0.616500675678253","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"$10,500","$21,000","Not Applicable","Not Applicable","$3,500","$0","$1,203","$30","$3,500","$0","$546","$80","61"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060063","Bronze 3500 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc663.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure663.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060063-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060064","Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060064-01","Standard Bronze On Exchange Plan",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","65"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060064","Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060064-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"66"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060064","Bronze 5000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc664.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure664.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060064-03","Limited Cost Sharing Plan Variation",,"0.593480467796326","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","20%",,,,"$15,000","$30,000","Not Applicable","Not Applicable","$5,000","$0","$502","$30","$5,000","$0","$64","$80","67"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060065","Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060065-00","Standard Bronze Off Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","68"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060065","Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060065-01","Standard Bronze On Exchange Plan",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","69"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060065","Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060065-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"70"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060065","Bronze 6000 Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Bronze","No","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc665.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure665.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060065-03","Limited Cost Sharing Plan Variation",,"0.582051515579224","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%",,,,"$18,000","$36,000","Not Applicable","Not Applicable","$6,000","$0","$151","$30","$5,320","$0","$0","$80","71"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060051","Catastrophic No Pediatric Dental","28162OH006","7376546504","OHN001","OHS001","OHF002","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc651.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure651.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060051-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable","$6,350","$0","$0","$30","$6,350","$0","$0","$80","80"
"2014","OH","28162","SERFF","3","2013-08-30 11:49:14","4","28162","OH","Individual","No","34-1624818","28162OH0060066","Catastrophic Select No Pediatric Dental","28162OH006","7376546504","OHN002","OHS001","OHF002","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","3","0","2014-01-01","2014-12-31","Yes","Generally, we may pay for limited Emergency Services that are necessary when You are traveling out of the USA, unless you are expressly traveling on business on behalf of Your Employer.  We will consider each Claim carefully.  We will not pay for Services when You go to another Country to obtain medical care.  We do not pay for air transport or medical evacuation.  We recommend that You obtain separate medical travel and evacuation insurance if You Plan to travel out of the USA.","Yes","Out of Service Area coverage from a network provider would be provided according to the plan benefits.  Out of Service Area coverage from a Non-Network provider would be covered at the Non-Network plan benefits and the member would be responsible for any amounts exceeding plan limitations.","No","http://www.aultcas.com/Application/na/getForm.aspx?sbc=sbc666.pdf","https://www.aultcas.com/aultcare/pmtlstner.aspx","http://www.aultcas.com/Application/na/getForm.aspx?sbcbroc=brochure666.pdf","http://www.AultCAS.com/acformularyb.aspx","28162OH0060066-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable","$6,350","$0","$0","$30","$6,350","$0","$0","$80","81"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","Individual","No","31-1440175","29276OH0740007","Anthem Bronze DirectAccess w/Child Dental - cdbu","29276OH074",,"OHN002","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4S","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740007-01","Standard Bronze On Exchange Plan","60.25%","0.666822671890259","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","Individual","Yes","31-1440175","29276OH0810001","Anthem Dental Pediatric","29276OH081",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$20.99",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Covered services performed by a non-network dentist are reimbursed at the out-of-network level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212906.pdf",,,,"29276OH0810001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0780001","Anthem Dental Pediatric","29276OH078",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$20.99",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Coverage is available  on an out-of-network  level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212906.pdf",,,,"29276OH0780001-01","Standard  On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750007","Anthem Gold DirectAccess Plus-grnb","29276OH075",,"OHN001","OHS001","OHF005","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992792801070448",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750007-01","Standard Gold On Exchange Plan","80.76%","0.810804069042206","No","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,000","$6,000","$3,000","$6,000","$9,000","$18,000","$12,000","$24,000","$1,000","$3,000","20%","$1,000","$3,000","20%","$3,000","$9,000","$4,000","$12,000","$0","$0","25%","$0","$0","25%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0780002","Anthem Dental PediatricEnhanced","29276OH078",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Coverage is available  on an out-of-network  level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e213349.pdf",,,,"29276OH0780002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","Individual","No","31-1440175","29276OH0740007","Anthem Bronze DirectAccess w/Child Dental - cdbu","29276OH074",,"OHN002","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4S","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","Individual","Yes","31-1440175","29276OH0810002","Anthem Dental PediatricEnhanced","29276OH081",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Covered services performed by a non-network dentist are reimbursed at the out-of-network level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e213349.pdf",,,,"29276OH0810002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","1","29276","OH","Individual","No","31-1440175","29276OH0740007","Anthem Bronze DirectAccess w/Child Dental - cdbu","29276OH074",,"OHN002","OHS001","OHF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4S","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740007-03","Limited Cost Sharing Plan Variation","60.25%","0.666822671890259","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%","$5,000","$10,000","50%","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750003","Anthem Silver DirectAccess Plus w/ HSA-gjbf","29276OH075",,"OHN001","OHS001","OHF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99110573170666",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750003-01","Standard Silver On Exchange Plan","69.87%","0.700797140598297","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,000","$8,000","$4,000","$8,000","$12,000","$24,000","$16,000","$32,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%","$2,000","$4,000","40%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","Individual","No","31-1440175","29276OH0740014","Anthem Gold DirectAccess w/Child Dental - cdcq","29276OH074",,"OHN002","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4T","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740014-01","Standard Gold On Exchange Plan","78.37%","0.754396557807922","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%","$1,250","$2,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0800001","Anthem Dental Family","29276OH080",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Coverage is available on an out of network basis","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212904.pdf",,,,"29276OH0800001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","Individual","Yes","31-1440175","29276OH0830001","Anthem Dental Family","29276OH083",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.47",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Covered services performed by a non-network dentist are reimbursed at the out-of-network level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212904.pdf",,,,"29276OH0830001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","Yes","31-1440175","29276OH0800002","Anthem Dental Family Enhanced","29276OH080",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Coverage is available on an out of network basis","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212905.pdf",,,,"29276OH0800002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","Individual","No","31-1440175","29276OH0740014","Anthem Gold DirectAccess w/Child Dental - cdcq","29276OH074",,"OHN002","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4T","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740014-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","Individual","Yes","31-1440175","29276OH0830002","Anthem Dental Family Enhanced","29276OH083",,"OHN001","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of country covered services are reimbursed as out-of-network expenses.","Yes","Covered services performed by a non-network dentist are reimbursed at the out-of-network level","Yes","http://www.anthem.com/agent/oh/f0/s0/t0/pw_e212905.pdf",,,,"29276OH0830002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","SHOP (Small Group)","No","31-1440175","29276OH0750004","Anthem Silver DirectAccess Plus w/ HSA-gkbf","29276OH075",,"OHN001","OHS001","OHF003","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.991083079040101",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0750004-01","Standard Silver On Exchange Plan","69.11%","0.69351327419281","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","$16,500","$33,000","$22,000","$44,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%","$2,000","$4,000","30%","$6,000","$12,000","$8,000","$16,000",,,,,,,,,"5"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","2","29276","OH","Individual","No","31-1440175","29276OH0740014","Anthem Gold DirectAccess w/Child Dental - cdcq","29276OH074",,"OHN002","OHS001","OHF014","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0U4T","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740014-03","Limited Cost Sharing Plan Variation","78.37%","0.754396557807922","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,000","$10,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%","$1,250","$2,500","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","3","29276","OH","Individual","No","31-1440175","29276OH0740006","Anthem Bronze DirectAccess - caaz","29276OH074",,"OHN001","OHS001","OHF005","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCT","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740006-03","Limited Cost Sharing Plan Variation","62.00%","0.630797326564789","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$16,650","$33,300","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,550","$11,100","20%","$5,550","$11,100","20%","$11,100","$22,200","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","4","29276","OH","Individual","No","31-1440175","29276OH0740012","Anthem Silver DirectAccess - cbwl","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SDH","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740012-01","Standard Silver On Exchange Plan","70.51%","0.708841383457184","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,750","$7,500","$3,750","$7,500","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","10%","$3,000","$6,000","40%","$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-05","87% AV Level Silver Plan","86.17%","0.861683309078217","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,150","$2,300","$1,150","$2,300","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,150","$2,300","0%","$1,150","$2,300","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740008","Anthem Silver DirectAccess w/HSA - cbey","29276OH074",,"OHN001","OHS001","OHF007","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SD1","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740008-06","94% AV Level Silver Plan","93.27%","0.932734072208405","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%","$500","$1,000","40%","$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740001","Anthem Bronze DirectAccess w/HSA - caas","29276OH074",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCN","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740001-01","Standard Bronze On Exchange Plan","58.32%","0.583816885948181","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","30%","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740001","Anthem Bronze DirectAccess w/HSA - caas","29276OH074",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCN","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","5","29276","OH","Individual","No","31-1440175","29276OH0740001","Anthem Bronze DirectAccess w/HSA - caas","29276OH074",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCN","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740001-03","Limited Cost Sharing Plan Variation","58.32%","0.583816885948181","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%","$6,000","$12,000","30%","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","29276","SERFF","8","2014-07-28 14:39:22","6","29276","OH","Individual","No","31-1440175","29276OH0740004","Anthem Bronze DirectAccess - caah","29276OH074",,"OHN001","OHS001","OHF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must be Pre-Approved","Yes","Must be Pre-Approved","No","http://www.sbc.anthem.com/dps/CCD0SCR","https://shop.anthem.com/sales/eox/payment/landing/oh","http://file.anthem.com/03258OHMENABS.pdf","www.anthem.com/OHSelectdrugtier4","29276OH0740004-01","Standard Bronze On Exchange Plan","61.98%","0.63432902097702","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","10%","$6,000","$12,000","40%","$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","30042","SERFF","1","2013-08-01 21:15:43","1","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0010001","Superior Dental Care Kids Plan - High","30042OH001",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$23.66",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Open network","Yes","Open network","No",,,,,"30042OH0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","$700","$1,400",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","30042","SERFF","1","2013-08-01 21:15:43","2","30042","OH","SHOP (Small Group)","Yes","31-1119867","30042OH0020001","Superior Dental Care, Kids Plan - Low","30042OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$18.72",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Open network","Yes","Open network","No",,,,,"30042OH0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","$700","$1,400",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$150","Not Applicable","$225","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","1","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0150001","EHB Basic Dental Plan (Low)","34968OH015","7326041556","OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$17.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48053",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48052",,"34968OH0150001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010012","Ambetter Bronze 3","41047OH001",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010012","Ambetter Bronze 3","41047OH001",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010013","Ambetter Bronze 4","41047OH001",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010013","Ambetter Bronze 4","41047OH001",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010013","Ambetter Bronze 4","41047OH001",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020004","Ambetter Gold 4 + Vision","41047OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020004","Ambetter Gold 4 + Vision","41047OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020004","Ambetter Gold 4 + Vision","41047OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020010","Ambetter Bronze 1 + Vision","41047OH002",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020010","Ambetter Bronze 1 + Vision","41047OH002",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020010","Ambetter Bronze 1 + Vision","41047OH002",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020012","Ambetter Bronze 3 + Vision","41047OH002",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","1","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0150001","EHB Basic Dental Plan (Low)","34968OH015","7326041556","OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$17.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48053",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48052",,"34968OH0150001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","2","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0160001","EHB Enhanced Dental Plan (High)","34968OH016","7326041556","OHN002","OHS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49114",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49113",,"34968OH0160001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","2","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0160001","EHB Enhanced Dental Plan (High)","34968OH016","7326041556","OHN002","OHS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$21.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49114",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49113",,"34968OH0160001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030002","Ambetter Gold 2 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-01","Standard Silver On Exchange Plan",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","22"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","23"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-03","Limited Cost Sharing Plan Variation",,"0.680991649627686","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$1,430","$150","$3,420","$540","$0","$80","24"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030007","Ambetter Silver 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020013","Ambetter Bronze 4 + Vision","41047OH002",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020013","Ambetter Bronze 4 + Vision","41047OH002",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","3","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0170001","Family Basic Dental Plan (Low)","34968OH017","7326041556","OHN003","OHS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$17.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49116",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49115",,"34968OH0170001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","3","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0170001","Family Basic Dental Plan (Low)","34968OH017","7326041556","OHN003","OHS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$17.21",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49116",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49115",,"34968OH0170001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","4","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0180001","Family Enhanced Dental Plan (High)","34968OH018","7326041556","OHN004","OHS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49118",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49117",,"34968OH0180001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020007","Ambetter Silver 3 + Vision","41047OH002",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020009","Ambetter Silver 5 + Vision","41047OH002",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","OH","34968","SERFF","5","2013-10-17 08:32:07","4","34968","OH","SHOP (Small Group)","Yes","13-5581829","34968OH0180001","Family Enhanced Dental Plan (High)","34968OH018","7326041556","OHN004","OHS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$21.55",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49118",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49117",,"34968OH0180001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030002","Ambetter Gold 2 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030002","Ambetter Gold 2 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030005","Ambetter Silver 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010002","Ambetter Gold 2","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010002","Ambetter Gold 2","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010002","Ambetter Gold 2","41047OH001",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010005","Ambetter Silver 1","41047OH001",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-04","73% AV Level Silver Plan",,"0.738758504390717","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,520","$0","$950","$150","$2,920","$520","$0","$80","25"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-05","87% AV Level Silver Plan",,"0.878752768039703","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$10","$510","$150","$700","$280","$110","$80","26"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010007","Ambetter Silver 3","41047OH001",,"OHN001","OHS001","OHF006","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010007-06","94% AV Level Silver Plan",,"0.944567024707794","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$0","$250","$150","$200","$50","$60","$80","27"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-01","Standard Silver On Exchange Plan","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","28"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","29"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-03","Limited Cost Sharing Plan Variation","68.13%","0.681264340877533","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$3,420","$270","$0","$80","30"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-04","73% AV Level Silver Plan","73.24%","0.732411444187164","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,020","$1,000","$0","$150","$2,920","$350","$0","$80","31"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","1","41047","OH","Individual","No","32-0045282","41047OH0010009","Ambetter Silver 5","41047OH001",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Gold 4","41047OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Gold 4","41047OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010004","Ambetter Gold 4","41047OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010010","Ambetter Bronze 1","41047OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010010","Ambetter Bronze 1","41047OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010010","Ambetter Bronze 1","41047OH001",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","2","41047","OH","Individual","No","32-0045282","41047OH0010012","Ambetter Bronze 3","41047OH001",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","3","41047","OH","Individual","No","32-0045282","41047OH0010008","Ambetter Silver 4","41047OH001",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0010008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020002","Ambetter Gold 2 + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020002-01","Standard Gold On Exchange Plan",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020002","Ambetter Gold 2 + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020002","Ambetter Gold 2 + Vision","41047OH002",,"OHN001","OHS001","OHF002","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020002-03","Limited Cost Sharing Plan Variation",,"0.781822621822357","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$50","$1,010","$150","$1,000","$930","$220","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-01","Standard Silver On Exchange Plan",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-03","Limited Cost Sharing Plan Variation",,"0.680714428424835","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$50","$1,520","$150","$2,500","$880","$180","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-04","73% AV Level Silver Plan",,"0.737214803695679","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,520","$20","$1,270","$150","$2,000","$770","$150","$80","13"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-05","87% AV Level Silver Plan",,"0.879959106445313","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$300","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$170","$10","$1,270","$150","$300","$300","$310","$80","14"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","4","41047","OH","Individual","No","32-0045282","41047OH0020005","Ambetter Silver 1 + Vision","41047OH002",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020005-06","94% AV Level Silver Plan",,"0.948886334896088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$70","$0","$260","$150","$100","$60","$70","$80","15"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020012","Ambetter Bronze 3 + Vision","41047OH002",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020012","Ambetter Bronze 3 + Vision","41047OH002",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","5","41047","OH","Individual","No","32-0045282","41047OH0020013","Ambetter Bronze 4 + Vision","41047OH002",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","6","41047","OH","Individual","No","32-0045282","41047OH0020008","Ambetter Silver 4 + Vision","41047OH002",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.983410196651312",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0020008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-05","87% AV Level Silver Plan","87.97%","0.879661500453949","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$520","$410","$0","$150","$600","$520","$0","$80","32"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","7","41047","OH","Individual","No","32-0045282","41047OH0030009","Ambetter Silver 5 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF008","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030009-06","94% AV Level Silver Plan","93.34%","0.933413624763489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$120","$0","$150","$0","$450","$0","$80","33"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030004","Ambetter Gold 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030004-01","Standard Gold On Exchange Plan",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030004","Ambetter Gold 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030004","Ambetter Gold 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030004-03","Limited Cost Sharing Plan Variation",,"0.782686412334442","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$0","$1,250","$150","$1,500","$350","$280","$80","9"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030010","Ambetter Bronze 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030010-01","Standard Bronze On Exchange Plan",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","10"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030010","Ambetter Bronze 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030010","Ambetter Bronze 1 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF009","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030010-03","Limited Cost Sharing Plan Variation",,"0.603424847126007","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$5,020","$0","$900","$150","$2,920","$860","$0","$80","12"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030012","Ambetter Bronze 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030012-01","Standard Bronze On Exchange Plan",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","16"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030012","Ambetter Bronze 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","17"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030012","Ambetter Bronze 3 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF011","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030012-03","Limited Cost Sharing Plan Variation",,"0.615748703479767","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$0","$350","$150","$5,270","$0","$0","$80","18"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030013","Ambetter Bronze 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030013-01","Standard Bronze On Exchange Plan",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","19"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030013","Ambetter Bronze 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030013-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","20"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","8","41047","OH","Individual","No","32-0045282","41047OH0030013","Ambetter Bronze 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF012","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,"$350","0","3","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030013-03","Limited Cost Sharing Plan Variation",,"0.616434097290039","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,000","$20","$1,300","$150","$4,000","$320","$170","$80","21"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-01","Standard Silver On Exchange Plan",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","4"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-03","Limited Cost Sharing Plan Variation",,"0.686699867248535","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$70","$1,010","$150","$2,000","$810","$190","$80","6"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-04","73% AV Level Silver Plan",,"0.738488256931305","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$40","$1,010","$150","$1,150","$600","$210","$80","7"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-05","87% AV Level Silver Plan",,"0.878983676433563","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$20","$510","$150","$500","$240","$120","$80","8"
"2014","OH","41047","SERFF","2","2013-09-02 14:52:56","9","41047","OH","Individual","No","32-0045282","41047OH0030008","Ambetter Silver 4 + Vision + Adult Dental","41047OH003",,"OHN001","OHS001","OHF007","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.952091211205737",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://ambetter.bchpohio.com/benefits","http://ambetter.bchpohio.com/payments","http://ambetter.bchpohio.com/ourplans","http://ambetter.bchpohio.com/formulary","41047OH0030008-06","94% AV Level Silver Plan",,"0.947933852672577","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$10","$250","$150","$100","$90","$70","$80","9"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020001","BESTOne Child Dental Plus","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Child_Dental_Plus_Plan.pdf",,"47509OH0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010001","BEST Life Child Dental Plus","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Child_Dental_Plus_Plan.pdf",,"47509OH0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020001","BESTOne Child Dental Plus","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Child_Dental_Plus_Plan.pdf",,"47509OH0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010001","BEST Life Child Dental Plus","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Child_Dental_Plus_Plan.pdf",,"47509OH0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010002","BEST Life Child Dental","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Child_Dental_Plan.pdf",,"47509OH0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020002","BESTOne Child Dental","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Child_Dental_Plan.pdf",,"47509OH0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010002","BEST Life Child Dental","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Child_Dental_Plan.pdf",,"47509OH0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020002","BESTOne Child Dental","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Child_Dental_Plan.pdf",,"47509OH0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020003","BESTOne Dental Advantage - Gold","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47509OH0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010003","BEST Dental Advantage - Gold","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47509OH0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010003","BEST Dental Advantage - Gold","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Advantage_Plan_(Gold).pdf",,"47509OH0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020003","BESTOne Dental Advantage - Gold","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"47509OH0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020004","BESTOne Dental Plus - Gold","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47509OH0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010004","BEST Dental Plus - Gold","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Plus_Plan_(Gold).pdf",,"47509OH0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010004","BEST Dental Plus - Gold","47509OH001",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.19",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Plus_Plan_(Gold).pdf",,"47509OH0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020004","BESTOne Dental Plus - Gold","47509OH002",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$43.99",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"47509OH0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020005","BESTOne Dental Plus - Silver","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"47509OH0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010005","BEST Dental Plus - Silver","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Plus_Plan_(Silver).pdf",,"47509OH0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020005","BESTOne Dental Plus - Silver","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"47509OH0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010005","BEST Dental Plus - Silver","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Plus_Plan_(Silver).pdf",,"47509OH0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020006","BESTOne Dental Basic - Silver","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47509OH0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010006","BEST Dental Basic - Silver","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Basic_Plan_(Silver).pdf",,"47509OH0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","SHOP (Small Group)","Yes","95-6042390","47509OH0010006","BEST Dental Basic - Silver","47509OH001",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.77",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BEST_Dental_Basic_Plan_(Silver).pdf",,"47509OH0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","OH","47509","SERFF","9","2014-01-21 11:24:32","1","47509","OH","Individual","Yes","95-6042390","47509OH0020006","BESTOne Dental Basic - Silver","47509OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.46",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/OH/pdf/OH_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"47509OH0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","OH","48333","SERFF","1","2013-08-01 21:15:43","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0040002","EHB High PPO","48333OH004",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$35.56",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48333OH0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","48333","SERFF","1","2013-08-01 21:15:43","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0040001","EHB Low PPO","48333OH004",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.92",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48333OH0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","48333","SERFF","1","2013-08-01 21:15:43","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0030002","EHB High Passive","48333OH003",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$42.16",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48333OH0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490019","SummaCare Gold 1000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490019-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-00","Standard Silver Off Exchange Plan",,"0.681113541126251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490020","SummaCare Gold 500 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490020-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-01","Standard Silver On Exchange Plan",,"0.681113541126251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490026","SummaCare Silver 2000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490026-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"53"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490027","SummaCare Gold 1000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490027-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490027","SummaCare Gold 1000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490027-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490028","SummaCare Gold 500 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490028-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490028","SummaCare Gold 500 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490028-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490030","SummaCare Gold 2000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490030-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"60"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-03","Limited Cost Sharing Plan Variation",,"0.681113541126251","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","Not Applicable","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-04","73% AV Level Silver Plan",,"0.738579034805298","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,225","$4,450","20%",,,,"$4,450","$8,900","Not Applicable","Not Applicable","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490022","SummaCare Gold 2000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490022-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490023","SummaCare Gold 1500 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490023-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490020","SummaCare Gold 500 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490020-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"42"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490002","SummaCare Gold 2000 S 12","52664OH149",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490002-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"99"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-06","94% AV Level Silver Plan",,"0.93194317817688","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","Not Applicable","Not Applicable","$200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490022","SummaCare Gold 2000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490022-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"44"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","Individual","No","34-1809108","52664OH1510013","SummaCare Individual 5000","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Silver","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualSilver5000","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510013-05","87% AV Level Silver Plan",,"0.866038262844086","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$4,500","$9,000","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","Not Applicable","Not Applicable","$200","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490023","SummaCare Gold 1500 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490023-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490026","SummaCare Silver 2000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490026-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"52"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490030","SummaCare Gold 2000 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490030-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"61"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490031","SummaCare Gold 1500 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490031-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"62"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490062","SummaCare Gold 2000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490062-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490063","SummaCare Gold 1500 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490063-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","OH","48333","SERFF","1","2013-08-01 21:15:43","1","48333","OH","SHOP (Small Group)","Yes","93-0242990","48333OH0030001","EHB Low Passive","48333OH003",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.88",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"48333OH0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490014","SummaCare Gold 2000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490014-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490010","SummaCare Silver 2000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490010-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490010","SummaCare Silver 2000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490010-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490094","SummaCare Gold 2000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490094-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"95"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490095","SummaCare Gold 1500 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490095-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"96"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490095","SummaCare Gold 1500 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490095-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"97"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490096","SummaCare Platinum 250 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490096-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"98"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490096","SummaCare Platinum 250 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490096-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"99"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","Individual","No","34-1809108","52664OH1510015","SummaCare Individual 750","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualGold750","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510015-00","Standard Gold Off Exchange Plan",,"0.785968244075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","$2,250","$4,500","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","Individual","No","34-1809108","52664OH1510015","SummaCare Individual 750","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualGold750","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510015-01","Standard Gold On Exchange Plan",,"0.785968244075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","$2,250","$4,500","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490098","SummaCare Silver 2000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490098-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490011","SummaCare Gold 1000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490011-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490003","SummaCare Gold 1000 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490003-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490003","SummaCare Gold 1000 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490003-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490004","SummaCare Gold 500 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490004-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490004","SummaCare Gold 500 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490004-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490005","SummaCare Silver 2000 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490005-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490005","SummaCare Silver 2000 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490005-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490007","SummaCare Gold 1500 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490007-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490059","SummaCare Gold 1000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490059-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490060","SummaCare Gold 500 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490060-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490043","SummaCare Gold 1000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490043-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"87"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490044","SummaCare Gold 500 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490044-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"88"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490044","SummaCare Gold 500 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490044-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"89"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490046","SummaCare Gold 2000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490046-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"92"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490050","SummaCare Silver 2000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490050-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490050","SummaCare Silver 2000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490050-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490060","SummaCare Gold 500 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490060-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490062","SummaCare Gold 2000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490062-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490007","SummaCare Gold 1500 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490007-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490008","SummaCare Platinum 250 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490008-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490008","SummaCare Platinum 250 S 12","52664OH149",,"OHN001","OHS001","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490008-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490011","SummaCare Gold 1000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490011-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490012","SummaCare Gold 500 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490012-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490024","SummaCare Platinum 250 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490024-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490024","SummaCare Platinum 250 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490024-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490052","SummaCare Gold 500 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490052-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","Individual","No","34-1809108","52664OH1520009","SummaCare Individual 6350","52664OH152",,"OHN001","OHS010","OHF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualBronze6350","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1520009-00","Standard Bronze Off Exchange Plan",,"0.605579555034637","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,"14"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490083","SummaCare Gold 1000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490083-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"73"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490084","SummaCare Gold 500 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490084-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"74"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490084","SummaCare Gold 500 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490084-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"75"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490086","SummaCare Gold 2000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490086-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"78"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490086","SummaCare Gold 2000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490086-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"79"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490087","SummaCare Gold 1500 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490087-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"80"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490012","SummaCare Gold 500 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490012-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490014","SummaCare Gold 2000 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490014-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490015","SummaCare Gold 1500 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490015-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490015","SummaCare Gold 1500 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490015-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490016","SummaCare Platinum 250 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490016-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490016","SummaCare Platinum 250 S 15","52664OH149",,"OHN001","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490016-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490018","SummaCare Silver 2000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490018-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490018","SummaCare Silver 2000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490018-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490019","SummaCare Gold 1000 S 11","52664OH149",,"OHN001","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490019-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490078","SummaCare Gold 2000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490078-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"62"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490055","SummaCare Gold 1500 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490055-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490055","SummaCare Gold 1500 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490055-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","Individual","No","34-1809108","52664OH1520009","SummaCare Individual 6350","52664OH152",,"OHN001","OHS010","OHF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualBronze6350","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1520009-03","Limited Cost Sharing Plan Variation",,"0.605579555034637","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,"17"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490056","SummaCare Platinum 250 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490056-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","Individual","No","34-1809108","52664OH1520010","SummaCare Individual Value","52664OH152",,"OHN001","OHS010","OHF005","New","PPO","Catastrophic","No","On the Exchange","No","No",,"Adult Only Plan","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualValueCatastrophic","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1520010-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,"18"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490092","SummaCare Gold 500 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490092-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"91"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490094","SummaCare Gold 2000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490094-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"94"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490056","SummaCare Platinum 250 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490056-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490058","SummaCare Silver 2000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490058-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490098","SummaCare Silver 2000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490098-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490099","SummaCare Gold 1000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490099-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500005","SummaCare Bronze 4000 S 11","52664OH150",,"OHN001","OHS003","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500005-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"13"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500007","SummaCare Bronze 4000 S 13","52664OH150",,"OHN001","OHS004","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500007-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"16"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500007","SummaCare Bronze 4000 S 13","52664OH150",,"OHN001","OHS004","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500007-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"17"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500009","SummaCare Bronze 4000 S 6","52664OH150",,"OHN001","OHS005","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500009-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"20"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490063","SummaCare Gold 1500 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490063-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490064","SummaCare Platinum 250 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490064-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490070","SummaCare Gold 2000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490070-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490071","SummaCare Gold 1500 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490071-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","Individual","No","34-1809108","52664OH1510015","SummaCare Individual 750","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualGold750","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","Individual","No","34-1809108","52664OH1510015","SummaCare Individual 750","52664OH151",,"OHN001","OHS010","OHF001","New","PPO","Gold","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualGold750","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1510015-03","Limited Cost Sharing Plan Variation",,"0.785968244075775","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$750","$1,500","20%",,,,"$1,500","$3,000","$2,250","$4,500","$250","Not Applicable","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490046","SummaCare Gold 2000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490046-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"93"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490047","SummaCare Gold 1500 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490047-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"94"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490047","SummaCare Gold 1500 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490047-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"95"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490048","SummaCare Platinum 250 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490048-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"96"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490048","SummaCare Platinum 250 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490048-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"97"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490002","SummaCare Gold 2000 S 12","52664OH149",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490002-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"98"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490031","SummaCare Gold 1500 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490031-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490032","SummaCare Platinum 250 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490032-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","Individual","No","34-1809108","52664OH1520009","SummaCare Individual 6350","52664OH152",,"OHN001","OHS010","OHF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualBronze6350","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1520009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"16"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490076","SummaCare Gold 500 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490076-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"59"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490032","SummaCare Platinum 250 S 13","52664OH149",,"OHN001","OHS004","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490032-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"65"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490034","SummaCare Silver 2000 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490034-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"68"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490064","SummaCare Platinum 250 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490064-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490066","SummaCare Silver 2000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490066-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490066","SummaCare Silver 2000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490066-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490067","SummaCare Gold 1000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490067-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490067","SummaCare Gold 1000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490067-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490068","SummaCare Gold 500 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490068-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490068","SummaCare Gold 500 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490068-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490070","SummaCare Gold 2000 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490070-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490034","SummaCare Silver 2000 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490034-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"69"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490035","SummaCare Gold 1000 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490035-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"70"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490035","SummaCare Gold 1000 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490035-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"71"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490036","SummaCare Gold 500 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490036-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"72"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490036","SummaCare Gold 500 S 6","52664OH149",,"OHN001","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490036-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"73"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490038","SummaCare Gold 2000 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490038-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"76"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490038","SummaCare Gold 2000 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490038-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"77"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490039","SummaCare Gold 1500 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490039-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$1,500","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"78"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490039","SummaCare Gold 1500 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490039-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$1,500","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"79"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490040","SummaCare Platinum 250 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490040-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"80"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490040","SummaCare Platinum 250 S 6","52664OH149",,"OHN001","OHS005","OHF004","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490040-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"81"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490042","SummaCare Silver 2000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490042-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"84"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490042","SummaCare Silver 2000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490042-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"85"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","1","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490043","SummaCare Gold 1000 S 14","52664OH149",,"OHN001","OHS006","OHF004","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490043-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"86"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490051","SummaCare Gold 1000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490051-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490051","SummaCare Gold 1000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490051-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490052","SummaCare Gold 500 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490052-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490054","SummaCare Gold 2000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490054-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","Individual","No","34-1809108","52664OH1520009","SummaCare Individual 6350","52664OH152",,"OHN001","OHS010","OHF005","New","PPO","Bronze","No","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","3","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareIndividualBronze6350","www.mysummacare.com/payment","www.mysummcare.com/individualplans","www.mysummacare.com/formulary","52664OH1520009-01","Standard Bronze On Exchange Plan",,"0.605579555034637","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,"15"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490054","SummaCare Gold 2000 S 16","52664OH149",,"OHN001","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490054-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490106","SummaCare Silver 2000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490106-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490107","SummaCare Gold 1000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490107-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490107","SummaCare Gold 1000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490107-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490108","SummaCare Gold 500 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490108-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490108","SummaCare Gold 500 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490108-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490110","SummaCare Gold 2000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490110-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490099","SummaCare Gold 1000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490099-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490100","SummaCare Gold 500 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490100-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500009","SummaCare Bronze 4000 S 6","52664OH150",,"OHN001","OHS005","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500009-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"21"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500011","SummaCare Bronze 4000 S 14","52664OH150",,"OHN001","OHS006","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500011-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"24"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490058","SummaCare Silver 2000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490058-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490059","SummaCare Gold 1000 P 12","52664OH149",,"OHN002","OHS001","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490059-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490071","SummaCare Gold 1500 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490071-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490072","SummaCare Platinum 250 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490072-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490072","SummaCare Platinum 250 P 15","52664OH149",,"OHN002","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490072-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490074","SummaCare Silver 2000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490074-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490074","SummaCare Silver 2000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490074-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490075","SummaCare Gold 1000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490075-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490075","SummaCare Gold 1000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490075-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490076","SummaCare Gold 500 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490076-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"58"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490103","SummaCare Gold 1500 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490103-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490104","SummaCare Platinum 250 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490104-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490104","SummaCare Platinum 250 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490104-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490106","SummaCare Silver 2000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490106-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490110","SummaCare Gold 2000 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490110-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490111","SummaCare Gold 1500 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490111-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490078","SummaCare Gold 2000 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490078-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490079","SummaCare Gold 1500 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490079-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490079","SummaCare Gold 1500 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490079-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"65"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490080","SummaCare Platinum 250 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490080-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"66"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490080","SummaCare Platinum 250 P 11","52664OH149",,"OHN002","OHS003","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490080-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"67"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490082","SummaCare Silver 2000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490082-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"70"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490082","SummaCare Silver 2000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490082-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"71"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490083","SummaCare Gold 1000 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490083-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"72"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490087","SummaCare Gold 1500 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490087-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"81"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490088","SummaCare Platinum 250 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490088-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"82"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500025","SummaCare Bronze 4000 P 14","52664OH150",,"OHN002","OHS006","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500025-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"53"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500027","SummaCare Bronze 4000 P 16","52664OH150",,"OHN002","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500027-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"56"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490119","SummaCare Gold 1500 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490119-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490120","SummaCare Platinum 250 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490120-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490120","SummaCare Platinum 250 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490120-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"51"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490122","SummaCare Silver 2000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490122-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490122","SummaCare Silver 2000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490122-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"55"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490123","SummaCare Gold 1000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490123-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490123","SummaCare Gold 1000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490123-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490124","SummaCare Gold 500 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490124-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"58"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490088","SummaCare Platinum 250 P 13","52664OH149",,"OHN002","OHS004","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490088-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"83"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490090","SummaCare Silver 2000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490090-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"86"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500013","SummaCare Bronze 4000 S 16","52664OH150",,"OHN001","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500013-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"29"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500015","SummaCare Bronze 4000 P 12","52664OH150",,"OHN002","OHS001","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500015-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"32"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500015","SummaCare Bronze 4000 P 12","52664OH150",,"OHN002","OHS001","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500015-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"33"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500017","SummaCare Bronze 4000 P 15","52664OH150",,"OHN002","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500017-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"36"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490090","SummaCare Silver 2000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490090-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"87"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490091","SummaCare Gold 1000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490091-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"88"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490091","SummaCare Gold 1000 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490091-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"89"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","2","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490092","SummaCare Gold 500 P 6","52664OH149",,"OHN002","OHS005","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490092-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"90"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490100","SummaCare Gold 500 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490100-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490102","SummaCare Gold 2000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490102-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490102","SummaCare Gold 2000 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490102-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490103","SummaCare Gold 1500 P 14","52664OH149",,"OHN002","OHS006","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490103-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","10","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0110001","Smile for Health Child C60A80","58255OH011",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","10","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0110002","Smile for Health Family C60A80","58255OH011",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0020001","Managed DentalGuard OH Child Essentials 1","59401OH002",,"OHN001","OHS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0020001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0020001","Managed DentalGuard OH Child Essentials 1","59401OH002",,"OHN001","OHS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0020001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0010001","Managed DentalGuard OH Child Essentials 2","59401OH001",,"OHN001","OHS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","1","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0010001","Managed DentalGuard OH Child Essentials 2","59401OH001",,"OHN001","OHS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$41.44",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0010001-01","Standard High On Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","2","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0030001","Managed DentalGuard OH10 Family Plan","59401OH003",,"OHN001","OHS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0030001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","2","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0030001","Managed DentalGuard OH10 Family Plan","59401OH003",,"OHN001","OHS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.00",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"59401OH0030001-01","Standard Low On Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","2","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0040001","Managed DentalGuard OH20 Family Plan","59401OH004",,"OHN001","OHS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"59401OH0040001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","59401","SERFF","3","2013-10-15 10:04:03","2","59401","OH","SHOP (Small Group)","Yes","27-4326698","59401OH0050001","Managed DentalGuard OH30 Family Plan","59401OH005",,"OHN001","OHS001",,"New","HMO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,,,,"59401OH0050001-00","Standard Low Off Exchange Plan","68.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","64353OH0010001-01","Standard Gold On Exchange Plan","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490111","SummaCare Gold 1500 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490111-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490112","SummaCare Platinum 250 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490112-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490112","SummaCare Platinum 250 P 16","52664OH149",,"OHN002","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490112-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490114","SummaCare Silver 2000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490114-00","Standard Silver Off Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-01","Standard Silver On Exchange Plan","69.10%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","64353OH0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","64353OH0010003-03","Limited Cost Sharing Plan Variation","61.30%","0.612853229045868","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","6"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","63"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","82"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500021","SummaCare Bronze 4000 P 13","52664OH150",,"OHN002","OHS004","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500021-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"45"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500023","SummaCare Bronze 4000 P 6","52664OH150",,"OHN002","OHS005","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500023-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"48"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010029-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","88"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490114","SummaCare Silver 2000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Silver","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareSilver2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490114-01","Standard Silver On Exchange Plan",,"0.719947695732117","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490115","SummaCare Gold 1000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490115-00","Standard Gold Off Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"40"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490115","SummaCare Gold 1000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490115-01","Standard Gold On Exchange Plan",,"0.791148602962494","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490116","SummaCare Gold 500 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490116-00","Standard Gold Off Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490116","SummaCare Gold 500 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490116-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490118","SummaCare Gold 2000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490118-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490118","SummaCare Gold 2000 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490118-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490119","SummaCare Gold 1500 MC 15","52664OH149",,"OHN003","OHS002","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490119-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490124","SummaCare Gold 500 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold500","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490124-01","Standard Gold On Exchange Plan",,"0.815665304660797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$9,000","$18,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"59"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490126","SummaCare Gold 2000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490126-00","Standard Gold Off Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"62"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490126","SummaCare Gold 2000 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold2000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490126-01","Standard Gold On Exchange Plan",,"0.79401421546936","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$2,000","$4,000","20%",,,,"$4,000","$8,000","$6,000","$12,000","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490127","SummaCare Gold 1500 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490127-00","Standard Gold Off Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","2","66083","OH","Individual","No","31-1154200","66083OH0610001","Humana Connect Basic 6350/6350 Plan","66083OH061",,"OHN001","OHS001","OHF001","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104843","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059343","http://apps.humana.com/marketing/documents.asp?file=2067338","66083OH0610001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","2","66083","OH","Individual","No","31-1154200","66083OH0610011","Humana Connect Basic 6350/6350 Plan","66083OH061",,"OHN002","OHS002","OHF001","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104843","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059343","http://apps.humana.com/marketing/documents.asp?file=2067338","66083OH0610011-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0130001","Guardian Pediatric Advantage","68158OH013",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0130001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0130001","Guardian Pediatric Advantage","68158OH013",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0130001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0140001","Guardian Pediatric Essentials","68158OH014",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0140001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","1","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0140001","Guardian Pediatric Essentials","68158OH014",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0140001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","2","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0150001","Guardian Family Advantage Plus","68158OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0150001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","2","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0150001","Guardian Family Advantage Plus","68158OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0150001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0170001","Guardian Family Essentials Plus","68158OH017",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0170001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","3","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0170001","Guardian Family Essentials Plus","68158OH017",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0170001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","4","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0160001","Guardian Family Advantage","68158OH016",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0160001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","4","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0160001","Guardian Family Advantage","68158OH016",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.46",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0160001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","4","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0180001","Guardian Family Essentials","68158OH018",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0180001-00","Standard Low Off Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","68158","SERFF","2","2013-09-05 10:37:54","4","68158","OH","SHOP (Small Group)","Yes","13-5123390","68158OH0180001","Guardian Family Essentials","68158OH018",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"68158OH0180001-01","Standard Low On Exchange Plan","68.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","237"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020015-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","46"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490127","SummaCare Gold 1500 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Gold","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareGold1500 ��","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490127-01","Standard Gold On Exchange Plan",,"0.811301648616791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$5,000","$10,000","$7,500","$15,000","$1,500","$3,000","0%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"65"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490128","SummaCare Platinum 250 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490128-00","Standard Platinum Off Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"66"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","3","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1490128","SummaCare Platinum 250 MC 16","52664OH149",,"OHN003","OHS007","OHF003","New","PPO","Platinum","No","Both","No","No",,"Adult Only- No child only on SHOP",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,"$150","0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareplatinum250","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1490128-01","Standard Platinum On Exchange Plan",,"0.892699182033539","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$2,000","$4,000","$3,000","$6,000","$250","$500","20%",,,,"$500","$1,000","$750","$1,500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"67"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500001","SummaCare Bronze 4000 S 12","52664OH150",,"OHN001","OHS001","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500001-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"4"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500001","SummaCare Bronze 4000 S 12","52664OH150",,"OHN001","OHS001","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500001-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"5"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500003","SummaCare Bronze 4000 S 15","52664OH150",,"OHN001","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500003-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"8"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500003","SummaCare Bronze 4000 S 15","52664OH150",,"OHN001","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500003-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"9"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500005","SummaCare Bronze 4000 S 11","52664OH150",,"OHN001","OHS003","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500005-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"12"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500011","SummaCare Bronze 4000 S 14","52664OH150",,"OHN001","OHS006","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500011-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"25"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500013","SummaCare Bronze 4000 S 16","52664OH150",,"OHN001","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500013-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"28"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500017","SummaCare Bronze 4000 P 15","52664OH150",,"OHN002","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500017-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"37"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500019","SummaCare Bronze 4000 P 11","52664OH150",,"OHN002","OHS003","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500019-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"40"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500019","SummaCare Bronze 4000 P 11","52664OH150",,"OHN002","OHS003","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500019-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"41"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500021","SummaCare Bronze 4000 P 13","52664OH150",,"OHN002","OHS004","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500021-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"44"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","64353OH0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","1","64353","OH","Individual","No","20-0750134","64353OH0010001","Molina Marketplace Gold Plan","64353OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/gold","64353OH0010001-03","Limited Cost Sharing Plan Variation","78.30%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010029-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","89"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","1","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0150001","Smile for Health Child C80A80","58255OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","1","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0150001","Smile for Health Child C80A80","58255OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","1","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0150002","Smile for Health Family C80A80","58255OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","1","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0150002","Smile for Health Family C80A80","58255OH015",,"OHN001","OHS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","3","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0190001","Smile for Health Child C60","58255OH019",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","4","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0200001","Smile for Health Child C80","58255OH020",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","235"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","236"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020015-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","47"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020015","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020015-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","48"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610014-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"23"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610014-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610015-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","59"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","60"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","97"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","98"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","99"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","208"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","209"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","210"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","211"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","212"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010085","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010085-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","213"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","232"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","142"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","143"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","144"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","145"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","146"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010074","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010074-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","147"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500023","SummaCare Bronze 4000 P 6","52664OH150",,"OHN002","OHS005","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500023-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"49"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500025","SummaCare Bronze 4000 P 14","52664OH150",,"OHN002","OHS006","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500025-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"52"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500027","SummaCare Bronze 4000 P 16","52664OH150",,"OHN002","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500027-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"57"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500029","SummaCare Bronze 4000 MC 15","52664OH150",,"OHN003","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500029-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"60"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500029","SummaCare Bronze 4000 MC 15","52664OH150",,"OHN003","OHS002","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500029-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"61"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500031","SummaCare Bronze 4000 MC 16","52664OH150",,"OHN003","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500031-00","Standard Bronze Off Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"64"
"2014","OH","52664","SERFF","8","2014-01-21 11:24:32","4","52664","OH","SHOP (Small Group)","No","34-1809108","52664OH1500031","SummaCare Bronze 4000 MC 16","52664OH150",,"OHN003","OHS007","OHF003","New","PPO","Bronze","No","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency and basic benefits at out of network benefit level, no pharmacy","Yes","All benefits at out of network benefit level except pharmacy","No","www.mysummacare.com/sbc/SummaCareBronze4000","www.mysummacare.com/payment","www.mysummacare.com/employerplans","www.mysummacare.com/formulary","52664OH1500031-01","Standard Bronze On Exchange Plan",,"0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,200","$38,400",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","$12,000","$24,000",,,,,,,,,"65"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","5","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0100001","Smile for Health Child C60A60","58255OH010",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","5","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0100001","Smile for Health Child C60A60","58255OH010",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$2,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610004-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610004","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610004-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610005-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","5","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0100002","Smile for Health Family C60A60","58255OH010",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","5","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0100002","Smile for Health Family C60A60","58255OH010",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","6","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0090001","Smile for Health Child C60A70","58255OH009",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","6","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0090001","Smile for Health Child C60A70","58255OH009",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","6","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0090002","Smile for Health Family C60A70","58255OH009",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-va-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-ppo","https://secure.ucci.com/docs/plan-brochure-va-ppo.pdf",,"58255OH0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","6","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0090002","Smile for Health Family C60A70","58255OH009",,"OHN001","OHS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$32.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-va-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-ppo","https://secure.ucci.com/docs/plan-brochure-va-ppo.pdf",,"58255OH0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$75","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","7","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0130001","Smile for Health Child C80A70","58255OH013",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","7","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0130002","Smile for Health Family C80A70","58255OH013",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","9","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0140001","Smile for Health Child C80A60","58255OH014",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/summary-of-coverage-oh-ppo.pdf","https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","58255","SERFF","1","2013-08-29 13:08:32","9","58255","OH","SHOP (Small Group)","Yes","86-0307623","58255OH0140002","Smile for Health Family C80A60","58255OH014",,"OHN001","OHS001",,"New","Indemnity","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$38.31",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-oh-ppo","https://secure.ucci.com/docs/plan-brochure-oh-ppo.pdf",,"58255OH0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,"$0","$0",,,,,"$0","$0","$50","$0",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-03","Limited Cost Sharing Plan Variation","69.10%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-04","73% AV Level Silver Plan","73.60%","0.733477354049683","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$300","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$920","$180","$80","7"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-05","87% AV Level Silver Plan","87.80%","0.877585172653198","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$680","$320","$80","8"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","2","64353","OH","Individual","No","20-0750134","64353OH0010002","Molina Marketplace Silver Plan","64353OH001",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.9951",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/silver","64353OH0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","OH","64353","SERFF","5","2013-10-15 10:04:03","3","64353","OH","Individual","No","20-0750134","64353OH0010003","Molina Marketplace Bronze Plan","64353OH001",,"OHN001","OHS002","OHF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/oh/en-us/hp/marketplace/plans/bronze","64353OH0010003-01","Standard Bronze On Exchange Plan","61.30%","0.612853229045868","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","4"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610003","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN001","OHS001","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610003-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount HMO Gold","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$100","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210001-01","Standard Gold On Exchange Plan",,"0.790509104728699","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$30","$1,010","$150","$1,050","$480","$190","$80","4"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount HMO Gold","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$100","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210001","Paramount HMO Gold","74313OH021",,"OHN001","OHS001","OHF004","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$100","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210001-03","Limited Cost Sharing Plan Variation",,"0.790509104728699","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$30","$1,010","$150","$1,050","$480","$190","$80","6"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-01","Standard Silver On Exchange Plan","68.13%","0.681272029876709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,900","$3,800","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,920","$70","$2,030","$150","$2,000","$840","$170","$80","7"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","8"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-03","Limited Cost Sharing Plan Variation","68.13%","0.681272029876709","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,900","$3,800","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,920","$70","$2,030","$150","$2,000","$840","$170","$80","9"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610005","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN001","OHS001","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610005-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610013","Humana Connect Silver 4600/6300 Plan","66083OH061",,"OHN002","OHS002","OHF002","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104869","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059382","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610013-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610014","Humana Connect Gold 2500/3500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104882","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059408","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610014-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","83"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","84"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","85"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","86"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010064","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010064-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","87"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","94"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","95"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010066","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010066-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","96"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","233"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010089","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010089-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","234"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610015-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"26"
"2014","OH","66083","SERFF","4","2014-01-22 11:51:12","1","66083","OH","Individual","No","31-1154200","66083OH0610015","Humana Connect Platinum 1000/1500 Plan","66083OH061",,"OHN002","OHS002","OHF003","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99999",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2104895","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059434","http://apps.humana.com/marketing/documents.asp?file=2067403","66083OH0610015-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-04","73% AV Level Silver Plan","73.63%","0.736308753490448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$50","$100","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,020","$60","$2,030","$150","$1,050","$950","$390","$80","10"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-05","87% AV Level Silver Plan","87.71%","0.877270817756653","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$500","$40","$510","$150","$500","$480","$120","$80","11"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","1","74313","OH","Individual","No","01-0580404","74313OH0210002","Paramount HMO Silver","74313OH021",,"OHN001","OHS001","OHF003","New","HMO","Silver","Yes","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210002-06","94% AV Level Silver Plan","94.72%","0.94720995426178","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$100","$30","$510","$150","$100","$250","$130","$80","12"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","2","74313","OH","Individual","No","01-0580404","74313OH0210003","Paramount HMO Bronze","74313OH021",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210003-01","Standard Bronze On Exchange Plan",,"0.592787623405457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$1,130","$150","$5,000","$80","$70","$80","4"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","2","74313","OH","Individual","No","01-0580404","74313OH0210003","Paramount HMO Bronze","74313OH021",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","2","74313","OH","Individual","No","01-0580404","74313OH0210003","Paramount HMO Bronze","74313OH021",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","On the Exchange","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,"$300","0","0","0","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210003-03","Limited Cost Sharing Plan Variation",,"0.592787623405457","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$20","$1,130","$150","$5,000","$80","$70","$80","6"
"2014","OH","74313","SERFF","4","2013-09-23 09:00:13","2","74313","OH","Individual","No","01-0580404","74313OH0210004","Paramount HMO Catastrophic","74313OH021",,"OHN001","OHS001","OHF001","New","HMO","Catastrophic","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Emergency Services which are required as the result of an Emergency Medical Condition are covered at any medical facility, anytime, anywhere without prior authorization. The service will be subject to an emergency room, urgent care facility or office visit Copay/Coinsurance, depending on where you receive treatment.","Yes","Limited. Out of service area coverage is available for emergency services or if the services have been prior-authorized.","No","www.paramounthealthcare.com/marketplace","www.paramount.softheon.com","www.paramounthealthcare.com/marketplace","http://www.paramounthealthcare.com/PreferredDrugLists","74313OH0210004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,350","$0","$0","$150","$5,020","$110","$0","$80","7"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010015-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","46"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010015-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","47"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010015","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010015-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","48"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010019-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","58"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010019-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","59"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010019","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010019-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","60"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010021-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","64"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010021-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","65"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010021","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010021-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","66"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010029","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010029-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","90"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010040-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","121"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010040-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","122"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010040","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010040-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","123"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010044-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","133"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010044-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","134"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","1","77552","OH","Individual","No","31-1143265","77552OH0010044","CareSource Just4me Ultra Healthcare with Heart","77552OH001",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010044-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","135"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","58"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","59"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","60"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","61"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","2","77552","OH","Individual","No","31-1143265","77552OH0010060","CareSource Just4me Healthcare with Heart","77552OH001",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Basic-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0010060-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","62"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020019-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","58"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020019-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","59"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020019","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020019-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","60"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020021-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","64"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020021-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","65"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020021","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020021-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","66"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020029-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","88"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020029-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","89"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020029","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020029-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","90"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020040-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","121"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020040-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","122"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020040","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020040-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","123"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020044-01","Standard Gold On Exchange Plan",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","133"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020044-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","134"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","3","77552","OH","Individual","No","31-1143265","77552OH0020044","CareSource Just4me Ultra Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Gold","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.961922775040951",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Gold-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020044-03","Limited Cost Sharing Plan Variation",,"0.807965815067291","No","No","No","100%",,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$30","$470","$150","$1,000","$450","$50","$80","135"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","58"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","61"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","62"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020060","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN002","OHS006","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020060-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","63"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","82"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","83"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","84"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","85"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","86"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020064","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS001","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020064-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","87"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","94"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","95"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","96"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","97"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","98"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020066","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN003","OHS003","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020066-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","99"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","142"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","143"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","144"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","145"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","146"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020074","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN004","OHS002","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020074-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","147"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","208"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","209"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","210"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","211"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","212"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020085","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS004","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020085-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","213"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-01","Standard Silver On Exchange Plan",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","232"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-02","Zero Cost Sharing Plan Variation",,"1","No","No","No","100%",,"$0","$0",,,"$0","$0","$0","$0","$0","$0",,,"$0","$0","$0","$0",,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","233"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-03","Limited Cost Sharing Plan Variation",,"0.690704524517059","No","No","No","100%",,"$4,850","$9,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$600","$0","$80","234"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-04","73% AV Level Silver Plan",,"0.739729642868042","No","No","No","100%",,"$4,450","$8,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,500","$20","$1,140","$150","$2,560","$400","$0","$80","235"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-05","87% AV Level Silver Plan",,"0.872699797153473","No","No","No","100%",,"$1,625","$3,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$625","$1,250",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,000","$20","$510","$150","$1,000","$250","$110","$80","236"
"2014","OH","77552","SERFF","6","2013-10-15 10:04:03","4","77552","OH","Individual","No","31-1143265","77552OH0020089","CareSource Just4me Dental and Vision!  Healthcare with Heart","77552OH002",,"OHN005","OHS008","OHF001","New","HMO","Silver","No","On the Exchange","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.96474883956662",,"$150","0","0","0","2014-01-01","2014-12-31","No",,"No",,"No","www.CareSource.com/Just4Me/Silver-Enhanced-SBC","www.CareSource.com/Just4Me/enroll","www.CareSource.com/Just4Me/Brochure","www.caresource.com/just4me/meds","77552OH0020089-06","94% AV Level Silver Plan",,"0.948802709579468","No","No","No","100%",,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"$150","$300","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$150","$10","$0","$150","$150","$50","$0","$80","237"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080005","HealthSpan 2000-80","92036OH008",,"OHN001","OHS003","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080005-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070005","HealthSpan 1000-80","92036OH007",,"OHN001","OHS003","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070005-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100005","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS003","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100005-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020006","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020006-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090005","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS003","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090005-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070005","HealthSpan 1000-80","92036OH007",,"OHN001","OHS003","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070005-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080006","HealthSpan 2000-80","92036OH008",,"OHN001","OHS005","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080006-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070006","HealthSpan 1000-80","92036OH007",,"OHN001","OHS005","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070006-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100006","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS005","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090006","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS005","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090006-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080006","HealthSpan 2000-80","92036OH008",,"OHN001","OHS005","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080006-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070006","HealthSpan 1000-80","92036OH007",,"OHN001","OHS005","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070006-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100006","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS005","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090006","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS005","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090006-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040005","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS003","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040005-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010005","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010005-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040006","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS005","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040006-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010006","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010006-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020005","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020005-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010006","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020006","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060006","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS005","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060006-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010006","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010006-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040006","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS005","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040006-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040008","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS007","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040008-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060008","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS007","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060008-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020005","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010005","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010005-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040005","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS003","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040005-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010006","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010006-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060006","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS005","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060006-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040006","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS005","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040006-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090015","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS002","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090015-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040008","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS007","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080015","HealthSpan 2000-80","92036OH008",,"OHN001","OHS002","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080015-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100015","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS002","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100015-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010008","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010008-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060008","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS007","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060008-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090005","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS003","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090005-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080005","HealthSpan 2000-80","92036OH008",,"OHN001","OHS003","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080005-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080008","HealthSpan 2000-80","92036OH008",,"OHN001","OHS007","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080008-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080008","HealthSpan 2000-80","92036OH008",,"OHN001","OHS007","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080008-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070008","HealthSpan 1000-80","92036OH007",,"OHN001","OHS007","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070008-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090008","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS007","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090008-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100008","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS007","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100008-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010005","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010005-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100005","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS003","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100005-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060005","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS003","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060005-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080012","HealthSpan 2000-80","92036OH008",,"OHN001","OHS004","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080012-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090008","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS007","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090008-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100008","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS007","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100008-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070008","HealthSpan 1000-80","92036OH007",,"OHN001","OHS007","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070008-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060005","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS003","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060005-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020005","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020005-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040005","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS003","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040005-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060006","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS005","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060006-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020006","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020006-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040006","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS005","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060006","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS005","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070012","HealthSpan 1000-80","92036OH007",,"OHN001","OHS004","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070012-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090012","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS004","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090012-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070015","HealthSpan 1000-80","92036OH007",,"OHN001","OHS002","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070015-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010008","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100012","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS004","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100012-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080012","HealthSpan 2000-80","92036OH008",,"OHN001","OHS004","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080012-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020006","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS005","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020006-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070012","HealthSpan 1000-80","92036OH007",,"OHN001","OHS004","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070012-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090012","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS004","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090012-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100012","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS004","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100012-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070027","HealthSpan 1000-80","92036OH007",,"OHN001","OHS006","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070027-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100027","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS006","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100027-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"58"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"58"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060012","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS004","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060012-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020026","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020026-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"103"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060005","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS003","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060005-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"20"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020005","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020005-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010005","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS003","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040005","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS003","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060005","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS003","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"22"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040008","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS007","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040008-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010008","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010008-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070015","HealthSpan 1000-80","92036OH007",,"OHN001","OHS002","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070015-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080015","HealthSpan 2000-80","92036OH008",,"OHN001","OHS002","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080015-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090015","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS002","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090015-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020008","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020008-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010012","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010012-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020012","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020012-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060012","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS004","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060012-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060015","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS002","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060015-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040015","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS002","OHF001","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040015-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020015","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020015-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100026","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS001","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100026-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090026","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090026-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080026","HealthSpan 2000-80","92036OH008",,"OHN001","OHS001","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080026-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100015","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS002","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100015-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060008","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS007","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060008-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020008","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020008-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040008","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS007","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040008-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060008","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS007","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020008","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"34"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010008","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010008-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020008","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS007","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020008-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050005","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS003","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050005-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030005","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS003","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030005-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080027","HealthSpan 2000-80","92036OH008",,"OHN001","OHS006","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080027-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090027","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS006","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090027-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"53"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"53"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"41"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"41"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"42"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"42"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020012","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020012-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080026","HealthSpan 2000-80","92036OH008",,"OHN001","OHS001","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080026-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070026","HealthSpan 1000-80","92036OH007",,"OHN001","OHS001","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070026-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040012","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS004","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040012-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050006","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS005","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050006-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030006","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS005","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030006-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010012","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010012-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040012","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS004","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040012-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010012","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010012-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060012","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS004","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060012-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040012","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS004","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040012-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020012","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020012-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"49"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060012","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS004","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"50"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010012","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"50"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020012","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS004","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"50"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040012","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS004","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"50"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090026","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS001","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090026-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070026","HealthSpan 1000-80","92036OH007",,"OHN001","OHS001","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070026-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100026","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS001","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100026-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010015","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010015-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"60"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080027","HealthSpan 2000-80","92036OH008",,"OHN001","OHS006","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080027-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070027","HealthSpan 1000-80","92036OH007",,"OHN001","OHS006","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070027-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090027","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS006","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090027-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100027","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS006","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100027-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030008","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS007","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030008-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060026","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060026-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090032","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS008","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090032-00","Standard Silver Off Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070032","HealthSpan 1000-80","92036OH007",,"OHN001","OHS008","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070032-00","Standard Gold Off Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"86"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"87"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"81"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"81"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"82"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"82"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"83"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"83"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060027","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS006","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060027-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"111"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020027","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020027-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"111"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040027","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS006","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040027-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"111"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010027","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010027-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"111"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020026","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010026","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010026-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"103"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060026","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060026-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010026","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010026-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020026","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020026-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040026","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS001","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040026-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"104"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040027","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS006","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040027-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"109"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020032","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"130"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040026","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS001","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040026-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060027","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS006","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060027-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020027","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020027-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020027","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020027-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"109"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010027","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010027-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"109"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010026","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040026","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS001","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050008","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS007","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050008-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010026","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010026-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040026","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS001","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040026-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020026","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS001","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020026-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"105"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040027","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS006","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040027-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010027","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010027-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"108"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060027","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS006","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060027-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"109"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"102"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"102"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040032","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS008","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"130"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060032","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS008","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"130"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010032","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"130"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010015","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010015-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060015","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS002","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060015-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100032","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS008","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100032-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080032","HealthSpan 2000-80","92036OH008",,"OHN001","OHS008","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080032-00","Standard Gold Off Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0090032","HealthSpan 2000-80 HSA","92036OH009",,"OHN001","OHS008","OHF004","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0090032-01","Standard Silver On Exchange Plan",,"0.717432618141174","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,800","$7,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020015","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020015-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040015","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS002","OHF001","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040015-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020015","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010015","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0070032","HealthSpan 1000-80","92036OH007",,"OHN001","OHS008","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan1000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0070032-01","Standard Gold On Exchange Plan",,"0.795232892036438","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0080032","HealthSpan 2000-80","92036OH008",,"OHN001","OHS008","OHF003","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"No","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,"$150","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpan2000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0080032-01","Standard Gold On Exchange Plan",,"0.809356987476349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","SHOP (Small Group)","No","31-1431434","92036OH0100032","HealthSpan 6000 HSA","92036OH010",,"OHN001","OHS008","OHF004","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.994586719009779",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0100032-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060015","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS002","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040015","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS002","OHF001","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"62"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010015","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010015-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060015","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS002","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060015-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020015","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS002","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020015-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040015","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS002","OHF001","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040015-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"84"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"84"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050012","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS004","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050012-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"85"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"85"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"86"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030012","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS004","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030012-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"87"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060026","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050015","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS002","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050015-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"106"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030015","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS002","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030015-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060026","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS001","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060026-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"107"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040032","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS008","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040032-03","Limited Cost Sharing Plan Variation",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"131"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020032","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020032-03","Limited Cost Sharing Plan Variation",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"131"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020027","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"110"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010027","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS006","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"110"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040027","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS006","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"110"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050001","Gold $5 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73105","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"5"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050003","Bronze $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73101","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0",,,"$0","$0",,,"14"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050003","Bronze $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73101","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","$12,000","$24,000","$5,600","$500",,,"$5,600","$10",,,"15"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050004","Bronze Deductible Only PPO HSA Eligible","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73102","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","$12,700","$25,400","$6,300","$0",,,"$6,300","$0",,,"16"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050004","Bronze Deductible Only PPO HSA Eligible","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73102","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0",,,"$0","$0",,,"17"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050001","Gold $5 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73105","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","$8,150","$16,300","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"6"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"7"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"223"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"223"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"224"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"224"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"225"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"225"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-05","87% AV Level Silver Plan","87.35%","0.873796045780182","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-06","94% AV Level Silver Plan","93.39%","0.933893859386444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040009","Market Classic 5000 - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040009-01","Standard Bronze On Exchange Plan","60.59%","0.605937421321869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040009","Market Classic 5000 - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040009","Market Classic 5000 - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040010","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040009-03","Limited Cost Sharing Plan Variation","60.59%","0.605937421321869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040010","Market Classic 5000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040010-01","Standard Bronze On Exchange Plan","60.59%","0.605937421321869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040010","Market Classic 5000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","3","99969","OH","Individual","No","34-1442712","99969OH0040010","Market Classic 5000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707429000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040010-03","Limited Cost Sharing Plan Variation","60.59%","0.605937421321869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","4","99969","OH","Individual","No","34-1442712","99969OH0040013","Market Young Adult Essentials","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707428000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$19,050","$38,100","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SD","13380","SERFF","1","2013-08-01 21:15:43","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0040002","EHB High PPO","13380SD004",,"SDN001","SDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.20",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"13380SD0040002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"182"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"182"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-01","Standard Silver On Exchange Plan","68.59%","0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-03","Limited Cost Sharing Plan Variation","68.59%","0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-04","73% AV Level Silver Plan","72.71%","0.727117776870728","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-05","87% AV Level Silver Plan","87.35%","0.873796045780182","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$4,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040005","Market Classic 2000 - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040006","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040005-06","94% AV Level Silver Plan","93.39%","0.933893859386444","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060027","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS006","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"110"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010032","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010032-00","Standard Gold Off Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"128"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060032","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS008","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060032-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"128"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040032","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS008","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040032-00","Standard Bronze Off Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"128"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020032","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020032-00","Standard Gold Off Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"128"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060032","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS008","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060032-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"129"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0020032","HealthSpanOne 1500-80","92036OH002",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne1500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0020032-01","Standard Gold On Exchange Plan",,"0.789516866207123","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"129"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010032","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010032-01","Standard Gold On Exchange Plan",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"129"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0040032","HealthSpanOne 6000-80","92036OH004",,"OHN001","OHS008","OHF005","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","2","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure?","www.HealthSpanBenefits.com/Formulary","92036OH0040032-01","Standard Bronze On Exchange Plan",,"0.618652701377869","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"129"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0010032","HealthSpanOne 500-80","92036OH001",,"OHN001","OHS008","OHF001","New","HMO","Gold","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne500-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0010032-03","Limited Cost Sharing Plan Variation",,"0.78139865398407","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"131"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0060032","HealthSpanOne 6000 HSA","92036OH006",,"OHN001","OHS008","OHF002","New","HMO","Bronze","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne6000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0060032-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"131"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"227"
"2014","OH","97596","SERFF","5","2014-01-21 11:24:32","1","97596","OH","Individual","Yes","39-1263473","97596OH0580001","Humana Dental Smart Choice","97596OH058",,"OHN001","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$33.31",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084290",,"97596OH0580001-01","Standard Low On Exchange Plan","68.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040004","Market HSA 2000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040004","Market HSA 2000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040004-03","Limited Cost Sharing Plan Variation",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040007","Market HSA 4000 - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040007-01","Standard Bronze On Exchange Plan",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040007","Market HSA 4000 - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"179"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"179"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"180"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"180"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"181"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"181"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"183"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"183"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"184"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"184"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$0",,,"$0","$0",,,"8"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"9"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","$10,150","$20,300","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$3,750","$250",,,"$3,750","$10",,,"10"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","$8,150","$16,300","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$10",,,"11"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050002","Silver $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73107","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","$6,400","$12,800","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$0","$250",,,"$0","$0",,,"12"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050003","Bronze $10 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73101","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","$12,000","$24,000","$5,600","$500",,,"$5,600","$10",,,"13"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030026","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS001","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030026-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"185"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050026","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS001","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050026-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"185"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"186"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"186"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"187"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"187"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"188"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"188"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-03","Limited Cost Sharing Plan Variation",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"189"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-03","Limited Cost Sharing Plan Variation",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"189"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-04","73% AV Level Silver Plan",,"0.737290322780609","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,675","$5,350",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,675","$5,350","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"190"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-04","73% AV Level Silver Plan",,"0.73425555229187","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"190"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"191"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"191"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030027","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS006","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030027-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"192"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050027","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS006","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050027-06","94% AV Level Silver Plan",,"0.944938838481903","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$400","$800","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"192"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050001","Gold $5 Copay PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73105","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","$8,150","$16,300","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$1,750","$250",,,"$1,750","$5",,,"4"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-00","Standard Silver Off Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"221"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-00","Standard Silver Off Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"221"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-01","Standard Silver On Exchange Plan",,"0.716980278491974","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"222"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-01","Standard Silver On Exchange Plan",,"0.705242514610291","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"222"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-01","Standard Silver On Exchange Plan","68.59%","0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"29"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0050032","HealthSpanOne 3000 HSA","92036OH005",,"OHN001","OHS008","OHF002","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,,"0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000HSASBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0050032-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"226"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-05","87% AV Level Silver Plan",,"0.870142996311188","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"226"
"2014","OH","92036","SERFF","6","2014-06-23 15:22:56","1","92036","OH","Individual","No","31-1431434","92036OH0030032","HealthSpanOne 3000-80","92036OH003",,"OHN001","OHS008","OHF001","New","HMO","Silver","No","Both","Yes","No",,"Out-of-network services not covered except for emergencies.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.992689708490448",,"$200","0","0","0","2014-01-01",,"No",,"Yes","Out-of-service area not covered except for emergencies or urgent care.","No","http://healthspansbc.com/s/HealthSpanOne3000-80SBC.pdf","https://healthspan.insxcloud.com/payment","http://www.healthspanbenefits.com/about/member-brochure","www.HealthSpanBenefits.com/Formulary","92036OH0030032-06","94% AV Level Silver Plan",,"0.933400392532349","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$600","$1,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"227"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040007","Market HSA 4000 - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040008","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040007-03","Limited Cost Sharing Plan Variation",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040008","Market HSA 4000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040008-01","Standard Bronze On Exchange Plan",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040008","Market HSA 4000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040008","Market HSA 4000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF006","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707431000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040008-03","Limited Cost Sharing Plan Variation",,"0.605500102043152","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$12,000","$24,000","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","1","98894","OH","Individual","No","75-1296086","98894OH0050004","Bronze Deductible Only PPO HSA Eligible","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73102","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","$12,700","$25,400","$6,300","$0",,,"$6,300","$0",,,"18"
"2014","OH","98894","SERFF","2","2013-09-05 10:37:54","2","98894","OH","Individual","No","75-1296086","98894OH0050005","Catastrophic 100% PPO Plan","98894OH005",,"OHN001","OHS001","OHF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes",,"1",,,"0","0","0","2014-01-01",,"No",,"No",,"No","http://www.coventryhealthcare.com/OH73104","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/ppooh","www.c1formularyhix.com","98894OH0050005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","$12,750","$25,500","$6,350","$0",,,"$6,350","$0",,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","Individual","Yes","31-1185262","99734OH0050001","Ohio DentaTrust PPO - Pediatric High Option","99734OH005",,"OHN003","OHS001",,"New","PPO","High",,"On the Exchange",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,,,,"Allows Child-Only",,,,"$27.59",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixindchildhighsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixindchildpolicy.dentalcareplus.com",,"99734OH0050001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0010002","HMO - Plan #002","99734OH001",,"OHN002","OHS002",,"New","HMO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$48.13",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,,,,"99734OH0010002-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","Individual","Yes","31-1185262","99734OH0050002","Ohio DentaTrust PPO - Pediatric Low Option","99734OH005",,"OHN003","OHS001",,"New","PPO","Low",,"On the Exchange",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,,,,"Allows Child-Only",,,,"$24.48",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixindchildlowsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixindchildpolicy.dentalcareplus.com",,"99734OH0050002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0010005","HMO - Plan #005","99734OH001",,"OHN002","OHS002",,"New","HMO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$49.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,,,,"99734OH0010005-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0010013","HMO - Plan #013","99734OH001",,"OHN002","OHS002",,"New","HMO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$39.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is limited to relief of pain, bleeding, swelling or other acute conditions.","No",,,,,"99734OH0010013-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$300",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020002","PPO - Plan #002","99734OH002",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$51.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,,,,"99734OH0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080003","Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080003-00","Standard Bronze Off Exchange Plan",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"4"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090004","Simplicity $3,000","31195SD009",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090004-00","Standard Bronze Off Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"4"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090004","Simplicity $3,000","31195SD009",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090004-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"5"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080003","Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080003-01","Standard Bronze On Exchange Plan",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"5"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080003","Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020003","PPO - Plan #003","99734OH002",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$52.14",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,,,,"99734OH0020003-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-03","Limited Cost Sharing Plan Variation","68.59%","0.685929417610168","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040006","Market Classic 2000 Child Only - Silver","99969OH004",,"OHN001","OHS001","OHF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707421000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040006-04","73% AV Level Silver Plan","72.71%","0.727117776870728","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"31"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020004","PPO - Plan #004","99734OH002",,"OHN001","OHS001",,"New","PPO","High",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$50.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,,,,"99734OH0020004-00","Standard High Off Exchange Plan","83.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010002","BEST Life Child Dental","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Child_Dental_Plan.pdf",,"61214SD0010002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020003","BESTOne Dental Advantage - Gold","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"61214SD0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010003","BEST Dental Advantage - Gold","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Advantage_Plan_(Gold).pdf",,"61214SD0010003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020003","BESTOne Dental Advantage - Gold","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"61214SD0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010003","BEST Dental Advantage - Gold","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Advantage_Plan_(Gold).pdf",,"61214SD0010003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020004","BESTOne Dental Plus - Gold","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"61214SD0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010004","BEST Dental Plus - Gold","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Plus_Plan_(Gold).pdf",,"61214SD0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010004","BEST Dental Plus - Gold","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Plus_Plan_(Gold).pdf",,"61214SD0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020004","BESTOne Dental Plus - Gold","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"61214SD0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080001","Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080001-01","Standard Gold On Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080001","Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090002","Simplicity $1,500","31195SD009",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090002-00","Standard Gold Off Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090002","Simplicity $1,500","31195SD009",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090002-01","Standard Gold On Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080001","Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080001-03","Limited Cost Sharing Plan Variation",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090003","Simplicity $2,000","31195SD009",,"SDN001","SDS001","SDF004","New","HMO","Silver","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090003-00","Standard Silver Off Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-00","Standard Silver Off Exchange Plan","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-01","Standard Silver On Exchange Plan","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","4"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010010","Avera $250 / 10% coinsurance","60536SD001",,"SDN001","SDS001","SDF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12074/Avera-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010010-01","Standard Platinum On Exchange Plan",,"0.880899608135223","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-00","Standard Silver Off Exchange Plan",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020002","BESTOne Child Dental","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Child_Dental_Plan.pdf",,"61214SD0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010002","BEST Life Child Dental","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Child_Dental_Plan.pdf",,"61214SD0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020002","BESTOne Child Dental","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Child_Dental_Plan.pdf",,"61214SD0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010005","BEST Dental Plus - Silver","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Plus_Plan_(Silver).pdf",,"61214SD0010005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","1","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0020012","PPO - Plan #012","99734OH002",,"OHN001","OHS001",,"New","PPO","Low",,"Off the Exchange",,,,"Please refer to the exclusions listed in the Certificate for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$41.06",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Out of Service Area coverage is provided for in-network services through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained outside of the service area from non-participating dentists.  See the schedule of benefits for in-network and out-of-network coverage levels.","Yes",,,,,"99734OH0020012-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","$300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","2","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040001","DentaSpan Dental PPO - Pediatric High Option","99734OH004",,"OHN003","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$25.56",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixsgchildhighsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixsgchildcert.dentalcareplus.com",,"99734OH0040001-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","2","99734","OH","Individual","Yes","31-1185262","99734OH0050003","Ohio DentaTrust PPO - Family High Option","99734OH005",,"OHN003","OHS001",,"New","PPO","High",,"On the Exchange",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$21.13",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixindfamilyhighsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixindfamilypolicy.dentalcareplus.com",,"99734OH0050003-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","2","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040002","DentaSpan Dental PPO - Pediatric Low Option","99734OH004",,"OHN003","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.72",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixsgchildlowsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixsgchildcert.dentalcareplus.com",,"99734OH0040002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","2","99734","OH","Individual","Yes","31-1185262","99734OH0050004","Ohio DentaTrust PPO - Family Low Option","99734OH005",,"OHN003","OHS001",,"New","PPO","Low",,"On the Exchange",,,,"Please refer to the exclusions listed in the Policy for specific plan level exclusions.",,,,,"Allows Adult and Child-Only",,,,"$15.78",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixindfamilylowsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixindfamilypolicy.dentalcareplus.com",,"99734OH0050004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","$300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040003","DentaSpan Dental PPO - Family High Option","99734OH004",,"OHN003","OHS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.99",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixsgfamilyhighsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixsgfamilycert.dentalcareplus.com",,"99734OH0040003-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99734","SERFF","4","2014-03-18 09:48:59","3","99734","OH","SHOP (Small Group)","Yes","31-1185262","99734OH0040004","DentaSpan Dental PPO - Family Low Option","99734OH004",,"OHN003","OHS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.65",,"Estimated Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Out of Service Area coverage is provided through dentists who participate in our National Network.  Out-of-Network coverage is also available for covered services obtained from non-participating dentists.  See the schedule of benefits for out-of-network coverage levels.","Yes","hixsgfamilylowsb.dentalcareplus.com","https://hixenroll.insxcloud.com/payment","hixsgfamilycert.dentalcareplus.com",,"99734OH0040004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$100","$300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","SHOP (Small Group)","Yes","34-1442712","99969OH0070001","Pediatric Plan 1","99969OH007",,"OHN001","OHS001",,"New","Indemnity","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$15.88",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Covered as Non-Network","Yes",,,,,"99969OH0070001-00","Standard Low Off Exchange Plan","69.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050007","Market Gold 2000 HSA","99969OH005",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707505000000000","https://bfi.shopapply.com/ProcessPayment.aspx�",,"https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0050007-00","Standard Gold Off Exchange Plan",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market Classic 1000 - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040001-01","Standard Gold On Exchange Plan",,"0.78582227230072","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050007","Market Gold 2000 HSA","99969OH005",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","Both","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707505000000000","https://bfi.shopapply.com/ProcessPayment.aspx�",,"https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0050007-01","Standard Gold On Exchange Plan",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$4,000","$8,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market Classic 1000 - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040001","Market Classic 1000 - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult-Only","99969OH0040002","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040001-03","Limited Cost Sharing Plan Variation",,"0.78582227230072","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Classic 1000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040002-01","Standard Gold On Exchange Plan",,"0.78582227230072","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Classic 1000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","1","99969","OH","Individual","No","34-1442712","99969OH0040002","Market Classic 1000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF002","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$150","0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707418000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040002-03","Limited Cost Sharing Plan Variation",,"0.78582227230072","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040003","Market HSA 2000 - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040003-01","Standard Gold On Exchange Plan",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2000","99969OH005",,"OHN001","OHS001","OHF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$250","0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707514000000000","https://bfi.shopapply.com/ProcessPayment.aspx�",,"https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0050013-00","Standard Silver Off Exchange Plan","70.22%","0.702236592769623","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","SHOP (Small Group)","No","34-1442712","99969OH0050013","Market Silver 3530-2000","99969OH005",,"OHN001","OHS001","OHF003","New","PPO","Silver","Yes","Both","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,"$250","0","0","3","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707514000000000","https://bfi.shopapply.com/ProcessPayment.aspx�",,"https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0050013-01","Standard Silver On Exchange Plan","70.22%","0.702236592769623","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","$0","$0","20%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040003","Market HSA 2000 - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040003","Market HSA 2000 - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040004","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040003-03","Limited Cost Sharing Plan Variation",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040004","Market HSA 2000 Child Only - Gold","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707420000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040004-01","Standard Gold On Exchange Plan",,"0.788134455680847","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","0%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040011","Market HSA 6000 - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040011-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040011","Market HSA 6000 - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040011","Market HSA 6000 - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult-Only","99969OH0040012","Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040011-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040012","Market HSA 6000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040012-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040012","Market HSA 6000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","OH","99969","SERFF","7","2014-03-18 09:48:59","2","99969","OH","Individual","No","34-1442712","99969OH0040012","Market HSA 6000 Child Only - Bronze","99969OH004",,"OHN001","OHS001","OHF004","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Covered as Non-Network","Yes","http://www.mybrokerlink.com/secured/broker_services/reference/ViewSBC.asp?ID=001707426000000000","https://bfi.shopapply.com/ProcessPayment.aspx","https://mybrokerlink.com/secured/broker_services/pdfs/brokers/shared/Z7907-IHP.pdf","https://member.express-scripts.com/web/formulary/OpenFormulary.do?portal=member&formularyId=393","99969OH0040012-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$18,000","$36,000","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","SD","13380","SERFF","1","2013-08-01 21:15:43","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0040001","EHB Low PPO","13380SD004",,"SDN001","SDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.04",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"13380SD0040001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","13380","SERFF","1","2013-08-01 21:15:43","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0030002","EHB High Passive","13380SD003",,"SDN001","SDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$44.80",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"13380SD0030002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SD","13380","SERFF","1","2013-08-01 21:15:43","1","13380","SD","SHOP (Small Group)","Yes","47-0098400","13380SD0030001","EHB Low Passive","13380SD003",,"SDN001","SDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.96",,"Estimated Rate",,"0","0","0","2014-01-01","2015-01-01","Yes","We convert the currency to U.S. dollars, based on the currency exchange rate on the date of service. We use the member's address to determine U&C, and benefits are released to the member in U.S. dollars.","Yes","Members can see the provider of their choice, even when the member is away from home, and even in an emergency. The same is true for dependents that may attend college away from home. Ameritas� online provider directory is available twenty-four hours every day, and can be used across the country to locate an in-network provider. To use the online directory, go to ameritasgroup.com and click on �Find a Provider.�","Yes","ameritasgroup.com","ameritasgroup.com","ameritasgroup.com",,"13380SD0030001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-01","Standard Silver On Exchange Plan","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090003","Simplicity $2,000","31195SD009",,"SDN001","SDS001","SDF004","New","HMO","Silver","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090003-01","Standard Silver On Exchange Plan",,"0.705296576023102","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,000","$4,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080003","Simplicity $5,000","31195SD008",,"SDN001","SDS001","SDF003","New","HMO","Bronze","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080003-03","Limited Cost Sharing Plan Variation",,"0.586283802986145","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,000","$18,000","$12,000","$18,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$6,000","$12,000","$6,000","$12,000",,,,,,,,,"7"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080004","Simplicity $6,350","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080004-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,"8"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","2","31195","SD","Individual","No","91-1842494","31195SD0080004","Simplicity $6,350","31195SD008",,"SDN001","SDS001","SDF002","New","HMO","Catastrophic","No","Both","Yes","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$18,000","$36,000","$18,000","$36,000",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$9,000","$18,000","$9,000","$18,000",,,,,,,,,"9"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-03","Limited Cost Sharing Plan Variation",,"0.687288999557495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"18"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","18167UT0010001-03","Limited Cost Sharing Plan Variation","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","6"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-03","Limited Cost Sharing Plan Variation","68.80%","0.688135981559753","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$1,700","$3,400","30%",,,,"Not Applicable","Not Applicable","$1,700","$3,400","$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,,,"$1,700","$410","$1,340","$150","$1,700","$870","$180","$80","6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010004","Avera $750 / 30% coinsurance","60536SD001",,"SDN001","SDS001","SDF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12075/Avera-750-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010004-01","Standard Gold On Exchange Plan",,"0.789073705673218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$750","$1,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","Individual","No","46-0451539","60536SD0020017","Avera MyPlan $250 / 10% Coinsurance","60536SD002",,"SDN001","SDS001","SDF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$33.20","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12053/Avera-MyPlan-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020017-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","Individual","No","46-0451539","60536SD0020017","Avera MyPlan $250 / 10% Coinsurance","60536SD002",,"SDN001","SDS001","SDF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$33.20","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12053/Avera-MyPlan-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020017-03","Limited Cost Sharing Plan Variation",,"0.880188286304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010005","Avera $2,000 / 20% coinsurance","60536SD001",,"SDN001","SDS001","SDF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12080/Avera-2000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010005-00","Standard Silver Off Exchange Plan",,"0.706195175647736","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280005","Blue 1500","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/351/Blue_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280005-00","Standard Gold Off Exchange Plan",,"0.783996403217316","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"8"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280005","Blue 1500","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/351/Blue_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280005-01","Standard Gold On Exchange Plan",,"0.783996403217316","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"9"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280005","Blue 1500","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/351/Blue_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280005","Blue 1500","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/351/Blue_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280005-03","Limited Cost Sharing Plan Variation",,"0.783996403217316","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"11"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280007","Blue 2000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/355/Blue_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280007-00","Standard Gold Off Exchange Plan",,"0.780153691768646","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"12"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280007","Blue 2000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/355/Blue_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280007-01","Standard Gold On Exchange Plan",,"0.780153691768646","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"13"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280007","Blue 2000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/355/Blue_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","SHOP (Small Group)","No","46-0401087","62210SD1330001","Select 1250A","62210SD133",,"SDN001","SDS001","SDF002","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/410/Files/374/Select_Group_1250_50-50_2250_x3_RX_E.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1330001-01","Standard Gold On Exchange Plan",,"0.790595889091492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$6,750",,,"Not Applicable","Not Applicable","$2,250","$6,750",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","50%",,,,"Not Applicable","Not Applicable","$1,250","$3,750","$1,250","$0","$1,000","$400","$1,100","$0","$0","$80","5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280001","Blue 1000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/347/Blue_Plan_1000_70-30_2500_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010004","Avera $750 / 30% coinsurance","60536SD001",,"SDN001","SDS001","SDF003","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12075/Avera-750-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010004-00","Standard Gold Off Exchange Plan",,"0.789073705673218","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$750","$1,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","3","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020003","Delta Dental Individual and Family Low","25868SD002",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108762.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020003-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","4","25868","SD","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual and Family High","25868SD001",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$46.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108756.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010004-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","6","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010003","Avera $1,000 / 20% coinsurance, Pediatric Dental","60536SD001",,"SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12076/Avera-1000-20-Coinsurance-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010003-01","Standard Gold On Exchange Plan",,"0.788689017295837","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","7","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010006","Avera $2,000 / $6,000 Out-of-Pocket","60536SD001",,"SDN001","SDS001","SDF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12079/Avera-2000-6000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010006-00","Standard Silver Off Exchange Plan",,"0.697121322154999","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$310","$1,450","$150",,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","7","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010006","Avera $2,000 / $6,000 Out-of-Pocket","60536SD001",,"SDN001","SDS001","SDF005","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12079/Avera-2000-6000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010006-01","Standard Silver On Exchange Plan",,"0.697121322154999","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$310","$1,450","$150",,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","8","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010007","Avera $2,000 / 30% Coinsurance","60536SD001",,"SDN001","SDS001","SDF006","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12082/Avera-2000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010007-00","Standard Silver Off Exchange Plan",,"0.714260995388031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$340","$1,450","$150",,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-04","73% AV Level Silver Plan",,"0.727333724498749","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,250","$9,750",,,"Not Applicable","Not Applicable","$3,250","$9,750",,,,,,,,,,,,,,,,,,,,,"$2,750","$8,250","30%",,,,"Not Applicable","Not Applicable","$2,750","$8,250",,,,,,,,,"16"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-05","87% AV Level Silver Plan",,"0.86667001247406","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,200","$3,600",,,"Not Applicable","Not Applicable","$1,200","$3,600",,,,,,,,,,,,,,,,,,,,,"$750","$2,250","30%",,,,"Not Applicable","Not Applicable","$750","$2,250",,,,,,,,,"17"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-06","94% AV Level Silver Plan",,"0.935619115829468","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,500",,,"Not Applicable","Not Applicable","$500","$1,500",,,,,,,,,,,,,,,,,,,,,"$350","$1,050","30%",,,,"Not Applicable","Not Applicable","$350","$1,050",,,,,,,,,"18"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370009","Red 6000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/373/Red_Plan_6000_80-20_6350_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370009-00","Standard Bronze Off Exchange Plan",,"0.612787127494812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"19"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 / 20% Coinsurance","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$70.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12057/Avera-MyPlan-1500-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020006-00","Standard Gold Off Exchange Plan",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 / 20% Coinsurance","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$70.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12057/Avera-MyPlan-1500-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020006-01","Standard Gold On Exchange Plan",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 / 20% Coinsurance","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$70.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12057/Avera-MyPlan-1500-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-03","Limited Cost Sharing Plan Variation","69.97%","0.699748456478119","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$10,000","$16,000","$10,000","$16,000","$2,500","$5,000","40%",,,,"$5,000","$10,000","$5,000","$10,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-04","73% AV Level Silver Plan","73.54%","0.735447406768799","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$6,350","$12,700","$6,350","$12,700","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-05","87% AV Level Silver Plan","87.16%","0.871599018573761","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$6,350","$12,700","$6,350","$12,700","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080002","Simplicity $2,500","31195SD008",,"SDN001","SDS001","SDF004","New","HMO","Silver","Yes","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080002-06","94% AV Level Silver Plan","94.10%","0.940972089767456","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$6,350","$12,700","$6,350","$12,700","$250","$500","20%",,,,"$500","$1,000","$500","$1,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010010","Avera $250 / 10% coinsurance","60536SD001",,"SDN001","SDS001","SDF009","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12074/Avera-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010010-00","Standard Platinum Off Exchange Plan",,"0.880899608135223","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$250","$500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020006","Avera MyPlan $1,500 / 20% Coinsurance","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$70.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12057/Avera-MyPlan-1500-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020006-03","Limited Cost Sharing Plan Variation",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","1","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020001","Delta Dental Pediatric Low","25868SD002",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108766.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","1","25868","SD","Individual","Yes","46-0309258","25868SD0010001","Delta Dental Pediatric Low","25868SD001",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$39.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108754.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","1","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020001","Delta Dental Pediatric Low","25868SD002",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108766.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","1","25868","SD","Individual","Yes","46-0309258","25868SD0010001","Delta Dental Pediatric Low","25868SD001",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$39.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108754.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","2","25868","SD","Individual","Yes","46-0309258","25868SD0010002","Delta Dental Pediatric High","25868SD001",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$46.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108752.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx","www.deltadentalsd.com",,"25868SD0010002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","2","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020002","Delta Dental Pediatric High","25868SD002",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18",,,,,"Allows Child-Only",,,,"$38.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108764.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020002-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$73.72","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12054/Avera-MyPlan-1500-20-Coinsurance-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020007-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010008","Avera $2,000 / 25% Coinsurance","60536SD001",,"SDN001","SDS001","SDF007","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12081/Avera-2000-25-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010008-00","Standard Silver Off Exchange Plan",,"0.706819891929626","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270001","Green 1000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/376/Green_Plan_1000_80-20_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270001-00","Standard Gold Off Exchange Plan",,"0.781732797622681","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","20%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270001","Green 1000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/376/Green_Plan_1000_80-20_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270001-01","Standard Gold On Exchange Plan",,"0.781732797622681","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","20%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270001","Green 1000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/376/Green_Plan_1000_80-20_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270001","Green 1000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/376/Green_Plan_1000_80-20_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270001-03","Limited Cost Sharing Plan Variation",,"0.781732797622681","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","20%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"7"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270005","Green 1500","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/360/Green_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270005-00","Standard Gold Off Exchange Plan",,"0.793219208717346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"8"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270005","Green 1500","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/360/Green_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270005-01","Standard Gold On Exchange Plan",,"0.793219208717346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"9"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","2","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020002","Delta Dental Pediatric High","25868SD002",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over the age of 18",,,,,"Allows Child-Only",,,,"$38.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108764.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020002-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","2","25868","SD","Individual","Yes","46-0309258","25868SD0010002","Delta Dental Pediatric High","25868SD001",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"Coverage not available for anyone over age 18.",,,,,"Allows Child-Only",,,,"$46.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108752.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx","www.deltadentalsd.com",,"25868SD0010002-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","3","25868","SD","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Low","25868SD001",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,,,,"Allows Adult and Child-Only",,,,"$39.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108758.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","3","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020003","Delta Dental Individual and Family Low","25868SD002",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$33.10",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108762.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020003-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","3","25868","SD","Individual","Yes","46-0309258","25868SD0010003","Delta Dental Individual and Family Low","25868SD001",,"SDN001","SDS001",,"New","Indemnity","Low",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18",,,,,"Allows Adult and Child-Only",,,,"$39.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108758.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010003-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","4","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020004","Delta Dental Individual and Family High","25868SD002",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$38.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108760.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020004-00","Standard High Off Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","4","25868","SD","Individual","Yes","46-0309258","25868SD0010004","Delta Dental Individual and Family High","25868SD001",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$46.20",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108756.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0010004-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","25868","SERFF","4","2014-01-24 09:49:15","4","25868","SD","SHOP (Small Group)","Yes","46-0309258","25868SD0020004","Delta Dental Individual and Family High","25868SD002",,"SDN001","SDS001",,"New","Indemnity","High",,"Both",,,,"EHB Pediatric coverage not available for anyone over the age of 18.",,,,,"Allows Adult and Child-Only",,,,"$38.80",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Care obtained from any Delta Dental Plan Association member company Premier provider is considered covered.  Through the Delta Dental Plan Association there is a nationwide Premier network presence.","Yes","http://www.deltadentalsd.com/documents/d108760.aspx?type=view","https://secure.deltadentalsd.com/ffm/default.aspx",,,"25868SD0020004-01","Standard High On Exchange Plan","86.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090001","Simplicity $500","31195SD009",,"SDN001","SDS001","SDF001","New","HMO","Platinum","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090001-00","Standard Platinum Off Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","Individual","No","91-1842494","31195SD0080001","Simplicity $1,500","31195SD008",,"SDN001","SDS001","SDF005","New","HMO","Gold","No","Both","Yes","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/individualplans",,"www.sanfordhealthplan.com/individualplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0080001-00","Standard Gold Off Exchange Plan",,"0.782246828079224","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","$6,000","$12,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$3,000","$6,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","31195","SERFF","2","2013-09-19 10:34:04","1","31195","SD","SHOP (Small Group)","No","91-1842494","31195SD0090001","Simplicity $500","31195SD009",,"SDN001","SDS001","SDF001","New","HMO","Platinum","No","Both","No","No",,,,"NO","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Emergency Only","Yes","Wrap Network","Yes","www.sanfordhealthplan.com/smallgroupplans",,"www.sanfordhealthplan.com/smallgroupplans","www.sanfordhealthplan.com/members/resources/pharmacyinformation","31195SD0090001-01","Standard Platinum On Exchange Plan",,"0.884950578212738","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$5,000","$10,000","$5,000","$10,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","40%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020005","BESTOne Dental Plus - Silver","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"61214SD0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010005","BEST Dental Plus - Silver","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Plus_Plan_(Silver).pdf",,"61214SD0010005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020005","BESTOne Dental Plus - Silver","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"61214SD0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020006","BESTOne Dental Basic - Silver","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"61214SD0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010006","BEST Dental Basic - Silver","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Basic_Plan_(Silver).pdf",,"61214SD0010006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010006","BEST Dental Basic - Silver","61214SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Dental_Basic_Plan_(Silver).pdf",,"61214SD0010006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020006","BESTOne Dental Basic - Silver","61214SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$30.01",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"61214SD0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-06","94% AV Level Silver Plan",,"0.935354471206665","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","50%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,"22"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270005","Green 1500","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/360/Green_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270005","Green 1500","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/360/Green_Plan_1500_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270005-03","Limited Cost Sharing Plan Variation",,"0.793219208717346","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"11"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270006","Green 2000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/362/Green_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270006-00","Standard Gold Off Exchange Plan",,"0.789320230484009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"12"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290012","Black 5000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/344/Black_Plan_5000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290012-03","Limited Cost Sharing Plan Variation",,"0.597524166107178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"36"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290013","Black 6350","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Catastrophic","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/345/Black_Plan_6350_100-0_6350.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290013-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"37"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290013","Black 6350","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Catastrophic","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/345/Black_Plan_6350_100-0_6350.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290013-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,"38"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-01","Standard Silver On Exchange Plan",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-03","Limited Cost Sharing Plan Variation",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-04","73% AV Level Silver Plan",,"0.728156566619873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-05","87% AV Level Silver Plan",,"0.862476468086243","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020009","Avera MyPlan $2,500 /$6,350 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.40","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12059/Avera-MyPlan-2500-6350-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020009-06","94% AV Level Silver Plan",,"0.938910305500031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280001","Blue 1000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/347/Blue_Plan_1000_70-30_2500_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280001-03","Limited Cost Sharing Plan Variation",,"0.810323774814606","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$7,500",,,"Not Applicable","Not Applicable","$2,500","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"7"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","SHOP (Small Group)","No","46-0401087","62210SD1330002","Select 1250B","62210SD133",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/410/Files/375/Select_Group_1250_50-50_4225_x3_RX_E.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1330002-01","Standard Silver On Exchange Plan",,"0.708365023136139","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,225","$12,675",,,"Not Applicable","Not Applicable","$4,225","$12,675",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","50%",,,,"Not Applicable","Not Applicable","$1,250","$3,750","$1,250","$0","$2,800","$400","$1,100","$0","$0","$80","7"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-04","73% AV Level Silver Plan",,"0.730168461799622","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"20"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-05","87% AV Level Silver Plan",,"0.864388465881348","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","50%",,,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,"21"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270006","Green 2000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/362/Green_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270006-01","Standard Gold On Exchange Plan",,"0.789320230484009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"13"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-03","Limited Cost Sharing Plan Variation",,"0.719027459621429","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,"11"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-04","73% AV Level Silver Plan",,"0.739344358444214","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"Not Applicable","Not Applicable","$3,750","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","30%",,,,"Not Applicable","Not Applicable","$1,200","$2,400",,,,,,,,,"12"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-05","87% AV Level Silver Plan",,"0.877315759658813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,"$300","$600","30%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,"13"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-06","94% AV Level Silver Plan",,"0.948408305644989","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$400","$800",,,"Not Applicable","Not Applicable","$400","$800",,,,,,,,,,,,,,,,,,,,,"$150","$300","30%",,,,"Not Applicable","Not Applicable","$150","$300",,,,,,,,,"14"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","18167UT0010001-01","Standard Gold On Exchange Plan","78.10%","0.781093120574951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$250","$500","20%",,,,"Not Applicable","Not Applicable","$250","$500","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$250","$300","$890","$150","$250","$1,120","$210","$80","4"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","1","18167","UT","Individual","No","33-0617992","18167UT0010001","Molina Marketplace Gold Plan","18167UT001",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/gold","18167UT0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270006","Green 2000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/362/Green_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270006","Green 2000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/362/Green_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270006-03","Limited Cost Sharing Plan Variation",,"0.789320230484009","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"15"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-00","Standard Silver Off Exchange Plan",,"0.684427797794342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"16"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-00","Standard Silver Off Exchange Plan",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-00","Standard Silver Off Exchange Plan",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-01","Standard Silver On Exchange Plan",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-03","Limited Cost Sharing Plan Variation",,"0.683463633060455","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-04","73% AV Level Silver Plan",,"0.728156566619873","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-05","87% AV Level Silver Plan",,"0.862476468086243","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-01","Standard Silver On Exchange Plan",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-03","Limited Cost Sharing Plan Variation",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-04","73% AV Level Silver Plan",,"0.732257664203644","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-05","87% AV Level Silver Plan",,"0.865615248680115","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020013","Avera MyPlan $2,500 / $5,500 Out-of-Pocket","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$91.74","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12058/Avera-MyPlan-2500--5500-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020013-06","94% AV Level Silver Plan",,"0.938384711742401","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-00","Standard Silver Off Exchange Plan",,"0.700577795505524","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-01","Standard Silver On Exchange Plan",,"0.700577795505524","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-03","Limited Cost Sharing Plan Variation",,"0.700577795505524","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-04","73% AV Level Silver Plan",,"0.728040814399719","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-05","87% AV Level Silver Plan",,"0.863391935825348","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","1","60536","SD","Individual","No","46-0451539","60536SD0020016","Avera MyPlan $1,500 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF016","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$98.96","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12064/Avera-MyPlan-1500-30-Coinsurance.pdf�","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020016-06","94% AV Level Silver Plan",,"0.930090248584747","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$200","$400","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010009","Avera $2,000 / $4,000 Out-of-Pocket","60536SD001",,"SDN001","SDS001","SDF008","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12078/Avera-2000-4000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010009-00","Standard Silver Off Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010009","Avera $2,000 / $4,000 Out-of-Pocket","60536SD001",,"SDN001","SDS001","SDF008","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12078/Avera-2000-4000-Out-of-Pocket.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010009-01","Standard Silver On Exchange Plan",,"0.699261426925659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$10,000","$20,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-05","87% AV Level Silver Plan",,"0.866531372070313","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,100","$2,200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,100","$2,200","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","2","60536","SD","Individual","No","46-0451539","60536SD0020011","Avera MyPlan H.S.A. $3,500","60536SD002",,"SDN001","SDS001","SDF012","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$97.39","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12060/Avera-MyPlan-HSA-3500.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020011-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010001","Avera $2,000 / 50% coinsurance","60536SD001",,"SDN001","SDS001","SDF001","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12083/Avera-2000-50-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010001-00","Standard Bronze Off Exchange Plan",,"0.619611322879791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","Individual","No","46-0451539","60536SD0020017","Avera MyPlan $250 / 10% Coinsurance","60536SD002",,"SDN001","SDS001","SDF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$33.20","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12053/Avera-MyPlan-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020017-00","Standard Platinum Off Exchange Plan",,"0.880188286304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","Individual","No","46-0451539","60536SD0020017","Avera MyPlan $250 / 10% Coinsurance","60536SD002",,"SDN001","SDS001","SDF017","New","PPO","Platinum","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$33.20","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12053/Avera-MyPlan-250-10-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020017-01","Standard Platinum On Exchange Plan",,"0.880188286304474","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","3","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010001","Avera $2,000 / 50% coinsurance","60536SD001",,"SDN001","SDS001","SDF001","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12083/Avera-2000-50-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010001-01","Standard Bronze On Exchange Plan",,"0.619611322879791","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","$200","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280007","Blue 2000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/355/Blue_Plan_2000_70-30_3000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280007-03","Limited Cost Sharing Plan Variation",,"0.780153691768646","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$9,000",,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,"15"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-00","Standard Silver Off Exchange Plan",,"0.681703507900238","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"16"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-01","Standard Silver On Exchange Plan",,"0.681703507900238","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"17"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280010","Blue 4000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/354/Blue_Plan_4000_50-50_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280010-03","Limited Cost Sharing Plan Variation",,"0.681703507900238","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","50%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"19"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$124.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020012-00","Standard Bronze Off Exchange Plan",,"0.613889932632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010005","Avera $2,000 / 20% coinsurance","60536SD001",,"SDN001","SDS001","SDF004","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12080/Avera-2000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010005-01","Standard Silver On Exchange Plan",,"0.706195175647736","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,250","$8,500",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$124.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020012-01","Standard Bronze On Exchange Plan",,"0.613889932632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$124.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020012-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020012","Avera MyPlan $5,000 / 30% Coinsurance","60536SD002",,"SDN001","SDS001","SDF013","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$124.62","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12063/Avera-MyPlan-5000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020012-03","Limited Cost Sharing Plan Variation",,"0.613889932632446","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020015","Avera MyPlan $6,000 / 30% coinsurance","60536SD002",,"SDN001","SDS001","SDF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$126.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12062/Avera-MyPlan-6000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020015-00","Standard Bronze Off Exchange Plan",,"0.603685796260834","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020015","Avera MyPlan $6,000 / 30% coinsurance","60536SD002",,"SDN001","SDS001","SDF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$126.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12062/Avera-MyPlan-6000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020015-01","Standard Bronze On Exchange Plan",,"0.603685796260834","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020015","Avera MyPlan $6,000 / 30% coinsurance","60536SD002",,"SDN001","SDS001","SDF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$126.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12062/Avera-MyPlan-6000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020015-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","4","60536","SD","Individual","No","46-0451539","60536SD0020015","Avera MyPlan $6,000 / 30% coinsurance","60536SD002",,"SDN001","SDS001","SDF015","New","PPO","Bronze","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$126.79","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12062/Avera-MyPlan-6000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020015-03","Limited Cost Sharing Plan Variation",,"0.603685796260834","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$6,000","$12,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$73.72","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12054/Avera-MyPlan-1500-20-Coinsurance-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020007-00","Standard Gold Off Exchange Plan",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010002","Avera $1,000 / 20% coinsurance","60536SD001",,"SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12077/Avera-1000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010002-00","Standard Gold Off Exchange Plan",,"0.788689017295837","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$73.72","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12054/Avera-MyPlan-1500-20-Coinsurance-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020007-01","Standard Gold On Exchange Plan",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010002","Avera $1,000 / 20% coinsurance","60536SD001",,"SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12077/Avera-1000-20-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010002-01","Standard Gold On Exchange Plan",,"0.788689017295837","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010008","Avera $2,000 / 25% Coinsurance","60536SD001",,"SDN001","SDS001","SDF007","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","5","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12081/Avera-2000-25-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010008-01","Standard Silver On Exchange Plan",,"0.706819891929626","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","25%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020007","Avera MyPlan $1,500 / 20% Coinsurance, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF010","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$73.72","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12054/Avera-MyPlan-1500-20-Coinsurance-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020007-03","Limited Cost Sharing Plan Variation",,"0.788982570171356","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020010","Avera MyPlan $2,500 /$6,350 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF011","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$108.81","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12056/Avera-MyPlan-2500-6350-Out-of-Pocket-pediatric-dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020010-06","94% AV Level Silver Plan",,"0.938910305500031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-00","Standard Silver Off Exchange Plan",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-01","Standard Silver On Exchange Plan",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-03","Limited Cost Sharing Plan Variation",,"0.711994588375092","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-04","73% AV Level Silver Plan",,"0.732257664203644","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,180","$10,360",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,250","$4,500","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-05","87% AV Level Silver Plan",,"0.865615248680115","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","5","60536","SD","Individual","No","46-0451539","60536SD0020014","Avera MyPlan $2,500 / $5,500 Out-of-Pocket, Pediatric Dental","60536SD002",,"SDN001","SDS001","SDF014","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$101.64","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12055/Avera-MyPlan-2500--5500-Out-of-Pocket-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020014-06","94% AV Level Silver Plan",,"0.938384711742401","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$350","$700","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","Not Applicable","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","6","60536","SD","Individual","No","46-0451539","60536SD0020018","Avera MyPlan $6,350","60536SD002",,"SDN001","SDS001","SDF018","New","PPO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12061/Avera-MyPlan-6350.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020018-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","6","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010003","Avera $1,000 / 20% coinsurance, Pediatric Dental","60536SD001",,"SDN001","SDS001","SDF002","New","PPO","Gold","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12076/Avera-1000-20-Coinsurance-Pediatric-Dental.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010003-00","Standard Gold Off Exchange Plan",,"0.788689017295837","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$10,000","$20,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","6","60536","SD","Individual","No","46-0451539","60536SD0020018","Avera MyPlan $6,350","60536SD002",,"SDN001","SDS001","SDF018","New","PPO","Catastrophic","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","3","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12061/Avera-MyPlan-6350.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0020018-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","SD","60536","SERFF","4","2013-09-16 08:58:26","8","60536","SD","SHOP (Small Group)","No","46-0451539","60536SD0010007","Avera $2,000 / 30% Coinsurance","60536SD001",,"SDN001","SDS001","SDF006","New","PPO","Silver","No","Both","No","No",,"Acupuncture, cosmetic surgery, dental care for adults, hearing aids, long-term care, routine eye care for adults and weight loss programs.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","2","2014-01-01","2014-12-31","Yes","Non-emergency services are covered if traveling outside of the United States. Precertification is required.","Yes","Services received outside of our service area will be covered at in-network benefits when received from one of our extended network providers. Out of network benefits are available for services received from all other providers.","No","https://www.avera.org/app/files/public/12082/Avera-2000-30-Coinsurance.pdf","www.Avera.org/PaymentReminder","www.Avera.org/PlanBrochure","www.Avera.org/DrugFormulary","60536SD0010007-01","Standard Silver On Exchange Plan",,"0.714260995388031","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$10,000","$20,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$5,000","$10,000","Not Applicable","Not Applicable","$0","$0","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,"$2,000","$340","$1,450","$150",,,,,"5"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020001","BESTOne Child Dental Plus","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Child_Dental_Plus_Plan.pdf",,"61214SD0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010001","BEST Life Child Dental Plus","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Child_Dental_Plus_Plan.pdf",,"61214SD0010001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","SHOP (Small Group)","Yes","95-6042390","61214SD0010001","BEST Life Child Dental Plus","61214SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.56",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BEST_Child_Dental_Plus_Plan.pdf",,"61214SD0010001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","61214","SERFF","6","2014-01-24 09:49:15","1","61214","SD","Individual","Yes","95-6042390","61214SD0020001","BESTOne Child Dental Plus","61214SD002",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$39.45",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/SD/pdf/SD_BESTOne_Child_Dental_Plus_Plan.pdf",,"61214SD0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","SHOP (Small Group)","No","46-0401087","62210SD1330001","Select 1250A","62210SD133",,"SDN001","SDS001","SDF002","Existing","HMO","Gold","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/410/Files/374/Select_Group_1250_50-50_2250_x3_RX_E.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1330001-00","Standard Gold Off Exchange Plan",,"0.790595889091492","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,"Not Applicable","Not Applicable","$2,250","$6,750",,,,,,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$1,250","$3,750","$1,250","$0","$1,000","$400","$1,100","$0","$0","$80","4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280001","Blue 1000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/347/Blue_Plan_1000_70-30_2500_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280001-00","Standard Gold Off Exchange Plan",,"0.810323774814606","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$7,500",,,"Not Applicable","Not Applicable","$2,500","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","Individual","No","46-0401087","62210SD1280001","Blue 1000","62210SD128",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"40% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/404/Files/347/Blue_Plan_1000_70-30_2500_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1280001-01","Standard Gold On Exchange Plan",,"0.810323774814606","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$7,500",,,"Not Applicable","Not Applicable","$2,500","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","1","62210","SD","SHOP (Small Group)","No","46-0401087","62210SD1330002","Select 1250B","62210SD133",,"SDN001","SDS001","SDF002","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.",,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/410/Files/375/Select_Group_1250_50-50_4225_x3_RX_E.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1330002-00","Standard Silver Off Exchange Plan",,"0.708365023136139","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,225","$12,675",,,"Not Applicable","Not Applicable","$4,225","$12,675",,,,,,,,,,,,,,,,,,,,,"$1,250","$3,750","50%",,,,"Not Applicable","Not Applicable","$1,250","$3,750","$1,250","$0","$2,800","$400","$1,100","$0","$0","$80","6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-01","Standard Silver On Exchange Plan",,"0.684427797794342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"17"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"18"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-03","Limited Cost Sharing Plan Variation",,"0.684427797794342","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"19"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-04","73% AV Level Silver Plan",,"0.725441753864288","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,"20"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-05","87% AV Level Silver Plan",,"0.865714013576508","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","30%",,,,"Not Applicable","Not Applicable","$750","$1,500",,,,,,,,,"21"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","2","62210","SD","Individual","No","46-0401087","62210SD1270008","Green 5000","62210SD127",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"30% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/406/Files/364/Green_Plan_5000_70-30_6000_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1270008-06","94% AV Level Silver Plan",,"0.934822142124176","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,"22"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370001","Red 1000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/365/Red_Plan_1000_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370001-00","Standard Gold Off Exchange Plan",,"0.81252658367157","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370001","Red 1000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/365/Red_Plan_1000_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370001-01","Standard Gold On Exchange Plan",,"0.81252658367157","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370001","Red 1000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/365/Red_Plan_1000_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370001","Red 1000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/365/Red_Plan_1000_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370001-03","Limited Cost Sharing Plan Variation",,"0.81252658367157","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,000","$3,000",,,,,,,,,"7"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-04","73% AV Level Silver Plan","73.30%","0.733477354049683","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","$5,200","$10,400","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$1,500","$370","$1,340","$150","$1,500","$720","$180","$80","7"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-05","87% AV Level Silver Plan","87.80%","0.875415086746216","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","25%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$310","$1,120","$150","$0","$600","$320","$80","8"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","2","18167","UT","Individual","No","33-0617992","18167UT0010002","Molina Marketplace Silver Plan","18167UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"0.991615914491015",,,"0","0","0","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/silver","18167UT0010002-06","94% AV Level Silver Plan","94.20%","0.942411482334137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","10%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$20","$450","$150","$0","$120","$130","$80","9"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","18167UT0010003-01","Standard Bronze On Exchange Plan","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","4"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","18167UT0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","UT","18167","SERFF","5","2014-07-30 17:22:07","3","18167","UT","Individual","No","33-0617992","18167UT0010003","Molina Marketplace Bronze Plan","18167UT001",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All but OBGYN",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"No","Urgent and emergent are covered","No","Urgent and emergent are covered","No","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","https://eportal.molinahealthcare.com/Member/Login","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","http://www.molinahealthcare.com/members/ut/en-us/hp/marketplace/plans/bronze","18167UT0010003-03","Limited Cost Sharing Plan Variation","61.30%","0.612636089324951","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700","$4,000","$8,000","40%",,,,"Not Applicable","Not Applicable","$4,000","$8,000","$300","$600","40%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,,,"$4,000","$20","$1,300","$150","$2,420","$1,000","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010001","Secure WELLth - 100% (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10001.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10001.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010001-00","Standard Bronze Off Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","$6,000","$12,000","$6,000","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010001","Secure WELLth - 100% (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10001.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10001.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010001-01","Standard Bronze On Exchange Plan",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","$6,000","$12,000","$6,000","$0","$0","$150","$5,270","$0","$0","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010001","Secure WELLth - 100% (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10001.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10001.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010001","Secure WELLth - 100% (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10001.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10001.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010001-03","Limited Cost Sharing Plan Variation",,"0.592071235179901","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"Not Applicable","Not Applicable","$6,000","$12,000","$6,000","$0","$0","$150","$5,270","$0","$0","$80","7"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370003","Red 1500","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/368/Red_Plan_1500_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370003-00","Standard Gold Off Exchange Plan",,"0.806654155254364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"8"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370003","Red 1500","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/368/Red_Plan_1500_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370003-01","Standard Gold On Exchange Plan",,"0.806654155254364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"9"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370003","Red 1500","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/368/Red_Plan_1500_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370003","Red 1500","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/368/Red_Plan_1500_70-30_2000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370003-03","Limited Cost Sharing Plan Variation",,"0.806654155254364","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$6,000",,,"Not Applicable","Not Applicable","$2,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$4,500","30%",,,,"Not Applicable","Not Applicable","$1,500","$4,500",,,,,,,,,"11"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-00","Standard Silver Off Exchange Plan",,"0.704017341136932","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,"12"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-01","Standard Silver On Exchange Plan",,"0.704017341136932","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,"13"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010012","Secure WELLth - Premium Saver (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF012","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10012.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10012.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010012-01","Standard Bronze On Exchange Plan",,"0.616087317466736","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$0","$2,330.00","$150","$2,500","$0","$1,030.00","$80","16"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010012","Secure WELLth - Premium Saver (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF012","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10012.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10012.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","17"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010012","Secure WELLth - Premium Saver (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF012","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10012.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10012.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010012-03","Limited Cost Sharing Plan Variation",,"0.616087317466736","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$0","$2,330.00","$150","$2,500","$0","$1,030.00","$80","18"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-00","Standard Silver Off Exchange Plan","69.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$1,680","$0","$150","$1,500","$460","$300","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-01","Standard Silver On Exchange Plan","69.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$1,680","$0","$150","$1,500","$460","$300","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370008","Red 3000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/372/Red_Plan_3000_70-30_4000_x3.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370008-03","Limited Cost Sharing Plan Variation",,"0.704017341136932","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$12,000",,,"Not Applicable","Not Applicable","$4,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$9,000","30%",,,,"Not Applicable","Not Applicable","$3,000","$9,000",,,,,,,,,"15"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370009","Red 6000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/373/Red_Plan_6000_80-20_6350_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370009-01","Standard Bronze On Exchange Plan",,"0.612787127494812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"20"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370009","Red 6000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/373/Red_Plan_6000_80-20_6350_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370009-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"21"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-01","Standard Silver On Exchange Plan",,"0.687288999557495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"16"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-04","73% AV Level Silver Plan",,"0.730409562587738","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"19"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-05","87% AV Level Silver Plan",,"0.877315759658813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,"$300","$600","30%",,,,"Not Applicable","Not Applicable","$300","$600",,,,,,,,,"20"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-06","94% AV Level Silver Plan",,"0.936959981918335","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$200","$400","30%",,,,"Not Applicable","Not Applicable","$200","$400",,,,,,,,,"21"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-00","Standard Silver Off Exchange Plan",,"0.699598968029022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,"22"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-01","Standard Silver On Exchange Plan",,"0.699598968029022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,"23"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-03","Limited Cost Sharing Plan Variation",,"0.699598968029022","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,"25"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","3","62210","SD","Individual","No","46-0401087","62210SD0370009","Red 6000","62210SD037",,"SDN001","SDS001","SDF003","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/408/Files/373/Red_Plan_6000_80-20_6350_x2.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD0370009-03","Limited Cost Sharing Plan Variation",,"0.612787127494812","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","20%",,,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,"22"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290002","Black 1250","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/335/Black_Plan_1250_70-30_2250.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290002-00","Standard Gold Off Exchange Plan",,"0.78733217716217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,"4"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290002","Black 1250","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/335/Black_Plan_1250_70-30_2250.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290002-01","Standard Gold On Exchange Plan",,"0.78733217716217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290002","Black 1250","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/335/Black_Plan_1250_70-30_2250.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290002","Black 1250","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Gold","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/335/Black_Plan_1250_70-30_2250.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290002-03","Limited Cost Sharing Plan Variation",,"0.78733217716217","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","30%",,,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,"7"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-00","Standard Silver Off Exchange Plan",,"0.719027459621429","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,"8"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-01","Standard Silver On Exchange Plan",,"0.719027459621429","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,"9"
"2014","SD","80261","SERFF","1","2013-08-01 21:15:43","1","80261","SD","SHOP (Small Group)","Yes","35-0472300","80261SD0010001","DentalConnect�","80261SD001",,"SDN001","SDS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.20",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"80261SD0010001-00","Standard High Off Exchange Plan","83.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80261","SERFF","1","2013-08-01 21:15:43","1","80261","SD","SHOP (Small Group)","Yes","35-0472300","80261SD0010002","DentalConnect�","80261SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.16",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"80261SD0010002-00","Standard Low Off Exchange Plan","71.66%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290005","Black 1500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/338/Black_Plan_1500_70-30_4000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"10"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290008","Black 2000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/341/Black_Plan_2000_70-30_4500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290008-00","Standard Silver Off Exchange Plan",,"0.687288999557495","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,"15"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-06","94% AV Level Silver Plan",,"0.943964660167694","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$500","$150","$0","$290","$210","$80","14"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010012","Secure WELLth - Premium Saver (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF012","New","HMO","Bronze","No","Both","No","No",,"See SPD","$38.75","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10012.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10012.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010012-00","Standard Bronze Off Exchange Plan",,"0.616087317466736","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","50%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$0","$2,330","$150","$2,500","$0","$1,030","$80","15"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-03","Limited Cost Sharing Plan Variation","69.80%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$1,680","$0","$150","$1,500","$460","$300","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-04","73% AV Level Silver Plan","72.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","$1,500","$3,000","$1,500","$1,500","$0","$150","$1,500","$460","$300","$80","8"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-04","73% AV Level Silver Plan",,"0.720562040805817","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,"26"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-05","87% AV Level Silver Plan",,"0.867854177951813","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","30%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,"27"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290010","Black 2500","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Silver","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/342/Black_Plan_2500_70-30_3500.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290010-06","94% AV Level Silver Plan",,"0.935770988464355","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,"28"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290011","Black 4000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/343/Black_Plan_4000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290011-00","Standard Bronze Off Exchange Plan",,"0.611795246601105","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"29"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290011","Black 4000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/343/Black_Plan_4000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290011-01","Standard Bronze On Exchange Plan",,"0.611795246601105","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"30"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290011","Black 4000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/343/Black_Plan_4000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290011-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"31"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290011","Black 4000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/343/Black_Plan_4000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290011-03","Limited Cost Sharing Plan Variation",,"0.611795246601105","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"Not Applicable","Not Applicable","$4,000","$8,000",,,,,,,,,"32"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","7","27619","UT","Individual","No","45-3174628","27619UT0010011","Classic No Worry Benefits","27619UT001",,"UTN001","UTS001","UTF011","New","HMO","Gold","Yes","Both","No","No",,"See SPD","$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10011.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10011.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010011-00","Standard Gold Off Exchange Plan","79.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,270","$150","$500","$610","$210","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","7","27619","UT","Individual","No","45-3174628","27619UT0010011","Classic No Worry Benefits","27619UT001",,"UTN001","UTS001","UTF011","New","HMO","Gold","Yes","Both","No","No",,"See SPD","$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10011.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10011.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010011-01","Standard Gold On Exchange Plan","79.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,270","$150","$500","$610","$210","$80","5"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290012","Black 5000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/344/Black_Plan_5000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290012-00","Standard Bronze Off Exchange Plan",,"0.597524166107178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"33"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290012","Black 5000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/344/Black_Plan_5000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290012-01","Standard Bronze On Exchange Plan",,"0.597524166107178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,"34"
"2014","SD","62210","SERFF","8","2014-06-23 15:22:56","4","62210","SD","Individual","No","46-0401087","62210SD1290012","Black 5000","62210SD129",,"SDN001","SDS001","SDF004","Existing","HMO","Bronze","No","Both","No","No",,"50% penalty may be applied to certain covered services when rendered by non-participating providers.","$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Non-emergency care requires preauthorization.","Yes","Preauthorization is required.","Yes","http://www.dakotacare.com/ClassLibrary/Page/Information/DataInstances/402/Files/344/Black_Plan_5000_70-30_6000.pdf","http://payment.dakotacare.com","http://www.dakotacare.com/benefitsummaries/index.cfm","http://www.dakotacare.com/toolsresources/pharmacyservices/","62210SD1290012-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"35"
"2014","SD","80261","SERFF","1","2013-08-01 21:15:43","2","80261","SD","SHOP (Small Group)","Yes","35-0472300","80261SD0010003","DentalConnect�","80261SD001",,"SDN001","SDS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"80261SD0010003-00","Standard Low Off Exchange Plan","71.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","1","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0010001","Guardian Pediatric Advantage","80608SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0010001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","1","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0010001","Guardian Pediatric Advantage","80608SD001",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0010001-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","1","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0020001","Guardian Pediatric Essentials","80608SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0020001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","1","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0020001","Guardian Pediatric Essentials","80608SD002",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0020001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","2","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0030001","Guardian Family Advantage Plus","80608SD003",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0030001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","2","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0030001","Guardian Family Advantage Plus","80608SD003",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0030001-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","3","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0050001","Guardian Family Essentials Plus","80608SD005",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0050001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","3","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0050001","Guardian Family Essentials Plus","80608SD005",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0050001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","Not Applicable",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","4","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0040001","Guardian Family Advantage","80608SD004",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0040001-00","Standard High Off Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","4","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0040001","Guardian Family Advantage","80608SD004",,"SDN001","SDS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$38.60",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0040001-01","Standard High On Exchange Plan","83.90%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","4","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0060001","Guardian Family Essentials","80608SD006",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0060001-00","Standard Low Off Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","SD","80608","SERFF","3","2013-09-16 08:58:26","4","80608","SD","SHOP (Small Group)","Yes","13-5123390","80608SD0060001","Guardian Family Essentials","80608SD006",,"SDN001","SDS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"80608SD0060001-01","Standard Low On Exchange Plan","70.50%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","14948","SERFF","3","2013-10-15 10:04:03","1","14948","UT","Individual","Yes","86-0672505","14948UT0010001","Deltacare USA Plan 70 for Children","14948UT001",,"UTN001","UTS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,,,"14948UT0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","14948","SERFF","3","2013-10-15 10:04:03","1","14948","UT","Individual","Yes","86-0672505","14948UT0010002","Deltacare USA Plan 85 for Children","14948UT001",,"UTN001","UTS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,,,"14948UT0010002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","14948","SERFF","3","2013-10-15 10:04:03","1","14948","UT","Individual","Yes","86-0672505","14948UT0010002","Deltacare USA Plan 85 for Children","14948UT001",,"UTN001","UTS001",,"New","HMO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$13.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,,,"14948UT0010002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010005","Healthy Lifestyle - Just the Basics","27619UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10005.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10005.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010005-03","Limited Cost Sharing Plan Variation","61.34%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$20","$900","$150","$5,000","$30","$60","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-00","Standard Silver Off Exchange Plan","71.41%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$20","$930","$150","$2,420","$400","$0","$80","8"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-01","Standard Silver On Exchange Plan","71.41%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$20","$930","$150","$2,420","$400","$0","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-03","Limited Cost Sharing Plan Variation","71.41%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$20","$930","$150","$2,420","$400","$0","$80","11"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-04","73% AV Level Silver Plan","73.51%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","$2,500","$5,000","$2,500","$20","$930","$150","$2,420","$400","$0","$80","12"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-05","87% AV Level Silver Plan","86.39%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,,,,,,,,,,,,,"$350","$700","20%",,,,"Not Applicable","Not Applicable","$350","$700","$350","$0","$1,150","$150","$350","$650","$210","$80","13"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010008","Elevated Healthy Lifestyle","27619UT001",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","3","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10008.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10008.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010008-06","94% AV Level Silver Plan","93.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$500","$150","$0","$360","$140","$80","14"
"2014","UT","14948","SERFF","3","2013-10-15 10:04:03","1","14948","UT","Individual","Yes","86-0672505","14948UT0010001","Deltacare USA Plan 70 for Children","14948UT001",,"UTN001","UTS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.99",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes",,,,,"14948UT0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-00","Standard Silver Off Exchange Plan",,"0.693848431110382","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","30%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$20","$1,650","$150","$1,750","$420","$280.00","$80","8"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-01","Standard Silver On Exchange Plan",,"0.693848431110382","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","30%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$20","$1,650.00","$150","$1,750","$420","$280.00","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-03","Limited Cost Sharing Plan Variation",,"0.693848431110382","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","30%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$20","$1,650.00","$150","$1,750","$420","$280.00","$80","11"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-04","73% AV Level Silver Plan",,"0.724965572357178","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","30%",,,,"Not Applicable","Not Applicable","$1,750","$3,500","$1,750","$20","$1,650.00","$150","$1,750","$420","$280","$80","12"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","1","27619","UT","Individual","No","45-3174628","27619UT0010002","Secure WELLth - No Worries (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF002","New","HMO","Silver","No","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10002.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10002.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010002-05","87% AV Level Silver Plan",,"0.861289799213409","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"Not Applicable","Not Applicable","$2,000","$4,000",,,,,,,,,,,,,,,,,,,,,"$100","$200","30%",,,,"Not Applicable","Not Applicable","$100","$200","$100","$0","$1,900","$150","$100","$600","$390","$80","13"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-05","87% AV Level Silver Plan","86.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$350","$700","30%",,,,"Not Applicable","Not Applicable","$350","$700","$350","$650","$0","$150","$350","$470","$180","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","2","27619","UT","Individual","No","45-3174628","27619UT0010003","Secure WELLth - Know Your Costs (HSA Qualified)","27619UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10003.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10003.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010003-06","94% AV Level Silver Plan","93.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$500","$0","$150","$0","$320","$180","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010005","Healthy Lifestyle - Just the Basics","27619UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10005.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10005.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010005-00","Standard Bronze Off Exchange Plan","61.34%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$20","$900","$150","$5,000","$30","$60","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010005","Healthy Lifestyle - Just the Basics","27619UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10005.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10005.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010005-01","Standard Bronze On Exchange Plan","61.34%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$20","$900","$150","$5,000","$30","$60","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","3","27619","UT","Individual","No","45-3174628","27619UT0010005","Healthy Lifestyle - Just the Basics","27619UT001",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","1","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10005.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10005.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-00","Standard Silver Off Exchange Plan","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-01","Standard Silver On Exchange Plan","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-03","Limited Cost Sharing Plan Variation","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-04","73% AV Level Silver Plan","73.45%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","8"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-05","87% AV Level Silver Plan","87.31%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","40%","$500","$1,000","40%","Not Applicable","Not Applicable","$500","$1,000","$500","$500","$0","$150","$500","$180","$320","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010006","Community Health Clinic - Smart Saver","27619UT001",,"UTN001","UTS003","UTF006","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10006.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10006.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010006-06","94% AV Level Silver Plan","94.20%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%","$0","$0","40%","Not Applicable","Not Applicable","$0","$0","$0","$500","$0","$150","$0","$170","$330","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-00","Standard Silver Off Exchange Plan","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","11"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-01","Standard Silver On Exchange Plan","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","12"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","13"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-03","Limited Cost Sharing Plan Variation","69.99%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","14"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-04","73% AV Level Silver Plan","73.45%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%","$3,000","$6,000","40%","Not Applicable","Not Applicable","$3,000","$6,000","$3,000","$910","$0","$150","$2,420","$200","$0","$80","15"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-05","87% AV Level Silver Plan","87.31%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$1,000","$2,000","Not Applicable","Not Applicable","$1,000","$2,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","40%","$500","$1,000","40%","Not Applicable","Not Applicable","$500","$1,000","$500","$500","$0","$150","$500","$180","$320","$80","16"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","4","27619","UT","Individual","No","45-3174628","27619UT0010013","Preferred Care Clinic- Smart Saver","27619UT001",,"UTN001","UTS002","UTF013","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10013.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10013.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010013-06","94% AV Level Silver Plan","94.20%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$500","$1,000","$500","$1,000","Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,,,"$0","$0","40%","$0","$0","40%","Not Applicable","Not Applicable","$0","$0","$0","$500","$0","$150","$0","$170","$330","$80","17"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-00","Standard Silver Off Exchange Plan","71.72%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$1,180","$0","$150","$2,000","$430","$100","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-01","Standard Silver On Exchange Plan","71.72%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$1,180","$0","$150","$2,000","$430","$100","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-03","Limited Cost Sharing Plan Variation","71.72%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$1,180","$0","$150","$2,000","$430","$100","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-04","73% AV Level Silver Plan","73.96%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","30%",,,,"Not Applicable","Not Applicable","$2,000","$4,000","$2,000","$1,180","$0","$150","$2,000","$430","$100","$80","8"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-05","87% AV Level Silver Plan","86.46%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,200","$4,400",,,"Not Applicable","Not Applicable","$2,200","$4,400",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$1,740","$0","$150","$250","$650","$310","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","5","27619","UT","Individual","No","45-3174628","27619UT0010007","Balanced Life - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF007","New","HMO","Silver","Yes","Both","No","No",,"See SPD","$29.06","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10007.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10007.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010007-06","94% AV Level Silver Plan","94.50%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","30%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$1,250","$0","$150","$0","$650","$380","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","6","27619","UT","Individual","No","45-3174628","27619UT0010010","Low Deductible - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF010","New","HMO","Gold","Yes","Both","No","No",,,"$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10010.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10010.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010010-00","Standard Gold Off Exchange Plan","78.09%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$1,740","$0","$150","$250","$650","$310","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","6","27619","UT","Individual","No","45-3174628","27619UT0010010","Low Deductible - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF010","New","HMO","Gold","Yes","Both","No","No",,,"$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10010.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10010.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010010-01","Standard Gold On Exchange Plan","78.09%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$1,740","$0","$150","$250","$650","$310","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","6","27619","UT","Individual","No","45-3174628","27619UT0010010","Low Deductible - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF010","New","HMO","Gold","Yes","Both","No","No",,,"$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10010.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10010.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010010-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","6","27619","UT","Individual","No","45-3174628","27619UT0010010","Low Deductible - Know Your Costs","27619UT001",,"UTN001","UTS001","UTF010","New","HMO","Gold","Yes","Both","No","No",,,"$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"3","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10010.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10010.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010010-03","Limited Cost Sharing Plan Variation","78.09%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"Not Applicable","Not Applicable","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$250","$500","30%",,,,"Not Applicable","Not Applicable","$250","$500","$250","$1,740","$0","$150","$250","$650","$310","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","7","27619","UT","Individual","No","45-3174628","27619UT0010011","Classic No Worry Benefits","27619UT001",,"UTN001","UTS001","UTF011","New","HMO","Gold","Yes","Both","No","No",,"See SPD","$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10011.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10011.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","7","27619","UT","Individual","No","45-3174628","27619UT0010011","Classic No Worry Benefits","27619UT001",,"UTN001","UTS001","UTF011","New","HMO","Gold","Yes","Both","No","No",,"See SPD","$19.38","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","0","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10011.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10011.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010011-03","Limited Cost Sharing Plan Variation","79.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"Not Applicable","Not Applicable","$500","$1,000","$500","$20","$1,270","$150","$500","$610","$210","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010016","Community Health Clinic - Just the Basics","27619UT001",,"UTN001","UTS003","UTF016","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10016.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10016.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010016-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","4"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010016","Community Health Clinic - Just the Basics","27619UT001",,"UTN001","UTS003","UTF016","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10016.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10016.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010016-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","5"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010016","Community Health Clinic - Just the Basics","27619UT001",,"UTN001","UTS003","UTF016","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10016.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10016.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010016-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","6"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010016","Community Health Clinic - Just the Basics","27619UT001",,"UTN001","UTS003","UTF016","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10016.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10016.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010016-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","7"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010017","Preferred Care Clinic - Just the Basics","27619UT001",,"UTN001","UTS002","UTF017","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10017.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10017.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010017-00","Standard Bronze Off Exchange Plan","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","8"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010017","Preferred Care Clinic - Just the Basics","27619UT001",,"UTN001","UTS002","UTF017","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10017.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10017.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010017-01","Standard Bronze On Exchange Plan","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","9"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010017","Preferred Care Clinic - Just the Basics","27619UT001",,"UTN001","UTS002","UTF017","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10017.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10017.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010017-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","$0","$0","$0","$0","$0","$150","$0","$0","$0","$80","10"
"2014","UT","27619","SERFF","7","2014-01-24 09:49:15","8","27619","UT","Individual","No","45-3174628","27619UT0010017","Preferred Care Clinic - Just the Basics","27619UT001",,"UTN001","UTS002","UTF017","New","HMO","Bronze","Yes","Both","No","No",,"See SPD","$38.75","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy",,"0.99",,,"0","0","2","2014-01-01","2014-12-31","Yes","Urgent or Emergency","Yes","Urgent or Emergency","Yes","www.archeshealth.org/SBC/10017.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2","www.archeshealth.org/productbrochure/10017.pdf","www.archeshealth.org/RxFormulary.html","27619UT0010017-03","Limited Cost Sharing Plan Variation","61.63%",,"Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%","$5,000","$10,000","40%","Not Applicable","Not Applicable","$5,000","$10,000","$5,000","$10","$900","$150","$5,000","$20","$60","$80","11"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","1","34541","UT","Individual","No","87-0388069","34541UT0030001","BridgeSpan Exchange Bronze HSA","34541UT003",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0030001-01","Standard Bronze On Exchange Plan",,"0.589279532432556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$680","$150","$5,000","$0","$70","$80","4"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","1","34541","UT","Individual","No","87-0388069","34541UT0030001","BridgeSpan Exchange Bronze HSA","34541UT003",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0030001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$80","5"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-04","73% AV Level Silver Plan","73.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-05","87% AV Level Silver Plan","87.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310003","Bronze $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF005","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73613","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310003-01","Standard Bronze On Exchange Plan","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","1","34541","UT","Individual","No","87-0388069","34541UT0030001","BridgeSpan Exchange Bronze HSA","34541UT003",,"UTN001","UTS001","UTF003","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0030001-03","Limited Cost Sharing Plan Variation",,"0.589279532432556","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"$12,500","$25,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","$5,000","$0","$680","$150","$5,000","$0","$70","$80","6"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan � Advantage Network","40335UT011",,"UTN002","UTS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0110001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0120001","EMI Health EHB Pediatric Plan � Premier Network","40335UT012",,"UTN001","UTS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$10.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0120001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0120001","EMI Health EHB Pediatric Plan � Premier Network","40335UT012",,"UTN001","UTS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$10.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0120001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020001","BESTOne Child Dental Plus","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Child_Dental_Plus_Plan.pdf",,"42757UT0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020001","BESTOne Child Dental Plus","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Child_Dental_Plus_Plan.pdf",,"42757UT0020001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020002","BESTOne Child Dental","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Child_Dental_Plan.pdf",,"42757UT0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020002","BESTOne Child Dental","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Child_Dental_Plan.pdf",,"42757UT0020002-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020003","BESTOne Dental Advantage - Gold","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"42757UT0020003-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020003","BESTOne Dental Advantage - Gold","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Advantage_Plan_(Gold).pdf",,"42757UT0020003-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020005","BESTOne Dental Plus - Silver","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"42757UT0020005-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020006","BESTOne Dental Basic - Silver","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"42757UT0020006-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020006","BESTOne Dental Basic - Silver","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Basic_Plan_(Silver).pdf",,"42757UT0020006-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","UT","46958","SERFF","4","2014-01-22 11:51:12","1","46958","UT","Individual","Yes","39-1263473","46958UT0460001","Humana Dental Smart Choice","46958UT046",,"UTN001","UTS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.05",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Any covered expense incurred for services received from an out of network provider will be covered at a lower coinsurance, based on the maximum allowable fee and providers can balance bill which will result in higher out of pocket costs, except for covered expense incurred for services received outside of the service area as required by law for emergency care services.","Yes",,,"http://apps.humana.com/marketing/documents.asp?file=2084407",,"46958UT0460001-01","Standard Low On Exchange Plan","71.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","1","40335","UT","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$10.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0010001-01","Standard High On Exchange Plan","87%",,,,"Yes","55%","45%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,"$50","$150",,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","2","40335","UT","Individual","Yes","20-4023720","40335UT0030001","EMI Health Choice PPO (Low)","40335UT003",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0030001-00","Standard High Off Exchange Plan","87.00%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,"$50","$150",,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","2","40335","UT","Individual","Yes","20-4023720","40335UT0030001","EMI Health Choice PPO (Low)","40335UT003",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.85",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0030001-01","Standard High On Exchange Plan","87.00%",,,,"Yes","60%","40%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,"$50","$150",,"$75","$225","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","3","40335","UT","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$9.12",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0020001-00","Standard High Off Exchange Plan","87.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","3","40335","UT","Individual","Yes","20-4023720","40335UT0020001","EMI Health Advantage Co-Pay","40335UT002",,"UTN002","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$9.12",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0020001-01","Standard High On Exchange Plan","87.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$25","$75",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","4","40335","UT","Individual","Yes","20-4023720","40335UT0110001","EMI Health EHB Pediatric Plan � Advantage Network","40335UT011",,"UTN002","UTS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.95",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"No",,"Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0110001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300004","Bronze Peak Preference HSA Eligible","38927UT030",,"UTN001","UTS001","UTF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73606","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300004-01","Standard Bronze On Exchange Plan","58.10%","0.582331299781799","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300004","Bronze Peak Preference HSA Eligible","38927UT030",,"UTN001","UTS001","UTF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73606","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"17"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300004","Bronze Peak Preference HSA Eligible","38927UT030",,"UTN001","UTS001","UTF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73606","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300004-03","Limited Cost Sharing Plan Variation","58.10%","0.582331299781799","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300005","Catastrophic Deductible Only Peak Preference","38927UT030",,"UTN001","UTS001","UTF004","New","HMO","Catastrophic","No","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73607","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-03","Limited Cost Sharing Plan Variation","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"86"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"21"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-01","Standard Silver On Exchange Plan","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010007-03","Limited Cost Sharing Plan Variation","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"58"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"59"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180006","SelectHealth Dental Classic","68781UT018",,"UTN006","UTS006",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180006-00","Standard High Off Exchange Plan","84.70%",,,,"No","100%",,"$30","$300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180006","SelectHealth Dental Classic","68781UT018",,"UTN006","UTS006",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.95",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180006-01","Standard High On Exchange Plan","84.70%",,,,"No","100%",,"$30","$300",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-04","73% AV Level Silver Plan","73.92%","0.738673806190491","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"87"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-03","Limited Cost Sharing Plan Variation",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-04","73% AV Level Silver Plan","73.92%","0.738673806190491","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010006-01","Standard Gold On Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030006-03","Limited Cost Sharing Plan Variation","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"82"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-00","Standard Silver Off Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"83"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010003-03","Limited Cost Sharing Plan Variation","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180004","SelectHealth Dental Prime","68781UT018",,"UTN005","UTS005",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$6.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180004-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$24","$240",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310003","Bronze $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF005","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73613","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310003","Bronze $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF005","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73613","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310003-03","Limited Cost Sharing Plan Variation","62.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310004","Bronze Deductible Only Altius POS HSA Eligible","38927UT031",,"UTN002","UTS002","UTF004","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310004-01","Standard Bronze On Exchange Plan","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310004","Bronze Deductible Only Altius POS HSA Eligible","38927UT031",,"UTN002","UTS002","UTF004","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310004-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310004","Bronze Deductible Only Altius POS HSA Eligible","38927UT031",,"UTN002","UTS002","UTF004","New","POS","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73614","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310004-03","Limited Cost Sharing Plan Variation","58.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310005","Catastrophic Deductible Only Altius POS","38927UT031",,"UTN002","UTS002","UTF007","New","POS","Catastrophic","No","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73615","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0010001","BridgeSpan Exchange Gold","34541UT001",,"UTN001","UTS001","UTF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0010001-01","Standard Gold On Exchange Plan",,"0.7903813123703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$5,000","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","4"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0010001","BridgeSpan Exchange Gold","34541UT001",,"UTN001","UTS001","UTF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0010001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$80","5"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0010001","BridgeSpan Exchange Gold","34541UT001",,"UTN001","UTS001","UTF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0010001-03","Limited Cost Sharing Plan Variation",,"0.7903813123703","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,300","$6,600",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$5,000","Not Applicable","Not Applicable","Not Applicable","$1,000","$20","$1,250","$150","$1,000","$360","$360","$80","6"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-01","Standard Silver On Exchange Plan",,"0.692280411720276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$2,300","$150","$3,000","$360","$1,430","$80","7"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020004","BESTOne Dental Plus - Gold","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"42757UT0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020004","BESTOne Dental Plus - Gold","42757UT002",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$24.89",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Plus_Plan_(Gold).pdf",,"42757UT0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","UT","42757","SERFF","6","2014-01-22 11:51:12","1","42757","UT","Individual","Yes","95-6042390","42757UT0020005","BESTOne Dental Plus - Silver","42757UT002",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$20.27",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Reimbursement at the UCR level","Yes",,"http://www.bestlife.com/pmt","http://www.bestlife.com/UT/pdf/UT_BESTOne_Dental_Plus_Plan_(Silver).pdf",,"42757UT0020005-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"$700","$1,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","Not Applicable","Not Applicable","Not Applicable","$0","$0","$0","$150","$0","$0","$0","$150","8"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-03","Limited Cost Sharing Plan Variation",,"0.692280411720276","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,900","$9,800",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$3,000","$0","$2,300","$150","$3,000","$360","$1,430","$80","9"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-04","73% AV Level Silver Plan",,"0.738602876663208","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$2,500","$20","$950","$150","$2,500","$320","$160","$80","10"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-05","87% AV Level Silver Plan",,"0.86993020772934","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,400","$2,800",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","20%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$500","$0","$1,000","$150","$500","$380","$440","$80","11"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","2","34541","UT","Individual","No","87-0388069","34541UT0020001","BridgeSpan Exchange Silver","34541UT002",,"UTN001","UTS001","UTF002","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0020001-06","94% AV Level Silver Plan",,"0.936659097671509","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","10%",,,,"$10,000","Not Applicable","Not Applicable","Not Applicable","$200","$0","$300","$150","$200","$240","$60","$80","12"
"2014","UT","34541","SERFF","3","2014-01-14 14:20:21","3","34541","UT","Individual","No","87-0388069","34541UT0040001","BridgeSpan Exchange Catastrophic","34541UT004",,"UTN001","UTS001","UTF004","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9987",,,"0","0","0","2014-01-01",,"Yes","Members traveling outside the United States receive coverage for the same benefits as inside the United States.","Yes","Out of Service Area benefits are covered at lower level of benefits but there is no out of service area network.� Members may be balance billed","No","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","www.bridgespanhealth.com","34541UT0040001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,500","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,500","Not Applicable","Not Applicable","Not Applicable","$6,250","$0","$0","$150","$5,270","$0","$0","$80","4"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300001","Gold $0 Peak Preference","38927UT030",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300001-01","Standard Gold On Exchange Plan","78.10%","0.744504690170288","No","Yes","Yes","65%","35%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300001","Gold $0 Peak Preference","38927UT030",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","Yes","65%","35%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300001","Gold $0 Peak Preference","38927UT030",,"UTN001","UTS001","UTF001","New","HMO","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73600","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300001-03","Limited Cost Sharing Plan Variation","78.10%","0.744504690170288","No","Yes","Yes","65%","35%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%","$2,000","$4,000","40%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-01","Standard Silver On Exchange Plan","68.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,800","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-03","Limited Cost Sharing Plan Variation","68.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,800","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-04","73% AV Level Silver Plan","72.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","30%","$4,900","$9,800","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$1,000","30%","$1,000","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,750","$3,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$0","$0","30%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300002","Silver $10 Peak Preference","38927UT030",,"UTN001","UTS001","UTF002","New","HMO","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73601","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300002-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","25%","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%","$0","$0","20%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300003","Bronze $15 Peak Preference","38927UT030",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300003-01","Standard Bronze On Exchange Plan","60.30%","0.584025144577026","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300003","Bronze $15 Peak Preference","38927UT030",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"14"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","1","38927","UT","Individual","No","87-0345631","38927UT0300003","Bronze $15 Peak Preference","38927UT030",,"UTN001","UTS001","UTF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73605","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmopeakpreferenceut","www.c1formularyhix.com","38927UT0300003-03","Limited Cost Sharing Plan Variation","60.30%","0.584025144577026","Yes","Yes","Yes","60%","40%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","30%","$6,000","$12,000","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310001","Gold $5 Altius POS","38927UT031",,"UTN002","UTS002","UTF007","New","POS","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73608","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310001","Gold $5 Altius POS","38927UT031",,"UTN002","UTS002","UTF007","New","POS","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73608","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310001","Gold $5 Altius POS","38927UT031",,"UTN002","UTS002","UTF007","New","POS","Gold","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73608","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$250","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-01","Standard Silver On Exchange Plan","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","38927","SERFF","7","2013-10-16 19:58:29","3","38927","UT","Individual","No","87-0345631","38927UT0310002","Silver $10 Altius POS","38927UT031",,"UTN002","UTS002","UTF008","New","POS","Silver","Yes","On the Exchange","No","No",,"See schedule of benefits for a full list of exclusions","$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01",,"Yes","Emergency Only","Yes","Emergency Only","No","http://www.coventryhealthcare.com/UT73609","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posaltiusut","www.c1formularyhix.com","38927UT0310002-03","Limited Cost Sharing Plan Variation","69.90%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$1,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","40335","SERFF","2","2013-10-15 10:04:03","1","40335","UT","Individual","Yes","20-4023720","40335UT0010001","EMI Health Choice PPO (High)","40335UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$10.05",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","PPO network or out-of-network coverage at PPO fee","Yes","emihealth.com","emihealth.com","emihealth.com",,"40335UT0010001-00","Standard High Off Exchange Plan","87%",,,,"Yes","55%","45%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","$75",,"$50","$150",,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-03","Limited Cost Sharing Plan Variation","68.80%","0.688010096549988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,600","$9,200","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030003-00","Standard Gold Off Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"68"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030003-01","Standard Gold On Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"69"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0120010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010004-03","Limited Cost Sharing Plan Variation","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-06","94% AV Level Silver Plan","94.68%","0.93706750869751","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010018-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-03","Limited Cost Sharing Plan Variation","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"93"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020007-00","Standard Gold Off Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"25"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-00","Standard Silver Off Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"53"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-01","Standard Silver On Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"54"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030001-01","Standard Gold On Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"65"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"66"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020003-03","Limited Cost Sharing Plan Variation","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"41"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-01","Standard Silver On Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 5350 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020011-00","Standard Bronze Off Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"77"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"78"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-05","87% AV Level Silver Plan","87.01%","0.870029091835022","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-06","94% AV Level Silver Plan","94.70%","0.946996092796326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-06","94% AV Level Silver Plan","94.70%","0.946996092796326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 5350 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"24"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020006-00","Standard Gold Off Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"49"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"70"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030003","Select Care Preference Gold 500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030003-03","Limited Cost Sharing Plan Variation","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"71"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"92"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020007-01","Standard Gold On Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-04","73% AV Level Silver Plan","72.52%","0.725208818912506","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,750","$9,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,250","$6,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-05","87% AV Level Silver Plan","86.35%","0.863511264324188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,450","$1,900",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$900","$1,800","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010004","Humana Connect Silver 4600/6300 Plan","56764UT001",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105259","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059707","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010004-06","94% AV Level Silver Plan","93.96%","0.939613163471222","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Connect Gold 2500/3500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105272","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059733","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010005-01","Standard Gold On Exchange Plan","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Connect Gold 2500/3500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105272","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059733","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010005","Humana Connect Gold 2500/3500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Gold","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105272","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059733","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010005-03","Limited Cost Sharing Plan Variation","78.29%","0.782948732376099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Connect Platinum 1000/1500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105285","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059759","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010006-01","Standard Platinum On Exchange Plan","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Connect Platinum 1000/1500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105285","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059759","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","1","56764","UT","Individual","No","20-8411422","56764UT0010006","Humana Connect Platinum 1000/1500 Plan","56764UT001",,"UTN001","UTS001","UTF004","New","HMO","Platinum","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105285","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059759","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010006-03","Limited Cost Sharing Plan Variation","90.55%","0.905480265617371","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","35%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","2","56764","UT","Individual","No","20-8411422","56764UT0010001","Humana Connect Basic 6350/6350 Plan","56764UT001",,"UTN001","UTS001","UTF001","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105220","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059642","http://apps.humana.com/marketing/documents.asp?file=2067351","56764UT0010001-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Connect Bronze 6300/6300 Plan","56764UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105233","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059655","http://apps.humana.com/marketing/documents.asp?file=2067351","56764UT0010002-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Connect Bronze 6300/6300 Plan","56764UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105233","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059655","http://apps.humana.com/marketing/documents.asp?file=2067351","56764UT0010002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"6"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","2","56764","UT","Individual","No","20-8411422","56764UT0010002","Humana Connect Bronze 6300/6300 Plan","56764UT001",,"UTN001","UTS001","UTF001","New","HMO","Bronze","No","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","0","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105233","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059655","http://apps.humana.com/marketing/documents.asp?file=2067351","56764UT0010002-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180005","SelectHealth Dental Classic","68781UT018",,"UTN006","UTS006",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$6.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180005-00","Standard Low Off Exchange Plan","69.90%",,,,"No","100%",,"$64","$640",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020002-00","Standard Gold Off Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020002-01","Standard Gold On Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-00","Standard Silver Off Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-01","Standard Silver On Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 5350 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010011-01","Standard Bronze On Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 5350 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","5","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Connect Bronze 4850/6350 Plan","56764UT001",,"UTN001","UTS001","UTF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105246","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059681","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010003-01","Standard Bronze On Exchange Plan","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","5","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Connect Bronze 4850/6350 Plan","56764UT001",,"UTN001","UTS001","UTF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105246","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059681","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","56764","SERFF","2","2013-09-02 14:52:56","5","56764","UT","Individual","No","20-8411422","56764UT0010003","Humana Connect Bronze 4850/6350 Plan","56764UT001",,"UTN001","UTS001","UTF002","New","HMO","Bronze","Yes","On the Exchange","Yes","Yes","All providers other than Family Practice, Pediatrician, Internal Medicine, General Practitioner and OB/GYN.",,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9908",,,"0","3","0","2014-01-01",,"Yes","Out of Country Coverage is covered for any expense incurred for services received outside of the United States as required by law for emergency care services.","Yes","Out of Service Area Coverage is covered for any covered expense incurred for services received outside of the service area as required by law for emergency care services or an approved referral is on file.","No","http://apps.humana.com/marketing/documents.asp?file=2105246","www.humana.com/mvc/HumanaOne/OHBPWelcome/FederalExchangeLandingPage","http://apps.humana.com/marketing/documents.asp?file=2059681","http://apps.humana.com/marketing/documents.asp?file=2067416","56764UT0010003-03","Limited Cost Sharing Plan Variation","61.43%","0.614312052726746","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,850","$9,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010001-00","Standard Gold Off Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180001","SelectHealth Dental Fundamental","68781UT018",,"UTN004","UTS004",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$4.47",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180001-00","Standard Low Off Exchange Plan","69.20%",,,,"No","100%",,"$44","$440",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010001-01","Standard Gold On Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180001","SelectHealth Dental Fundamental","68781UT018",,"UTN004","UTS004",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$4.47",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180001-01","Standard Low On Exchange Plan","69.20%",,,,"No","100%",,"$44","$440",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180002","SelectHealth Dental Fundamental","68781UT018",,"UTN004","UTS004",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$5.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180002-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$20","$200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010001","Select Value Preference Gold 250","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010001-03","Limited Cost Sharing Plan Variation","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180002","SelectHealth Dental Fundamental","68781UT018",,"UTN004","UTS004",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$5.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180002-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$20","$200",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010003-00","Standard Gold Off Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180003","SelectHealth Dental Prime","68781UT018",,"UTN005","UTS005",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$5.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180003-00","Standard Low Off Exchange Plan","70.70%",,,,"No","100%",,"$52","$520",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010003-01","Standard Gold On Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180003","SelectHealth Dental Prime","68781UT018",,"UTN005","UTS005",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$5.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180003-01","Standard Low On Exchange Plan","70.70%",,,,"No","100%",,"$52","$520",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010003","Select Value Preference Gold 500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180004","SelectHealth Dental Prime","68781UT018",,"UTN005","UTS005",,"New","HMO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$6.68",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180004-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$24","$240",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","Yes","87-0409820","68781UT0180005","SelectHealth Dental Classic","68781UT018",,"UTN006","UTS006",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$6.52",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"No",,"selecthealth.org/ffmpayment/dental.aspx","http://selecthealth.org/plans/dental/Pages/Pediatric Dental.aspx",,"68781UT0180005-01","Standard Low On Exchange Plan","69.90%",,,,"No","100%",,"$64","$640",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"13"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010005","Select Value Preference Silver 1000","68781UT001",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010006-00","Standard Gold Off Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010006","Select Value Preference Gold 1000","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010006-03","Limited Cost Sharing Plan Variation","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"22"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-00","Standard Silver Off Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-01","Standard Silver On Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"24"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010008","Select Value Preference Silver 2500","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010008-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0010010","Select Value Preference Bronze 5000","68781UT001",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020001-00","Standard Gold Off Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020001-01","Standard Gold On Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"36"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020001","Select Med Preference Gold 250","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020001-03","Limited Cost Sharing Plan Variation","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020003-00","Standard Gold Off Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"38"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020003-01","Standard Gold On Exchange Plan","78.50%","0.788360893726349","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020003","Select Med Preference Gold 500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020003-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020003-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"40"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"44"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010018-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-00","Standard Silver Off Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"33"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-05","87% AV Level Silver Plan","87.77%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","$0","$0","$0","$30","$560","$150","$0","$300","$280","$80","8"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-06","94% AV Level Silver Plan","93.22%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$0","$520","$150","$0","$0","$140","$80","9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-05","87% AV Level Silver Plan","87.01%","0.870029091835022","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"45"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380003","BlueChoice Gold $1,000","10207VA038",,"VAN001","VAS001","VAF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996222588414248",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7CRXCVCN7AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","14"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380003","BlueChoice Gold $1,000","10207VA038",,"VAN001","VAS001","VAF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996222588414248",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7CRXCVCN7AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380003-03","Limited Cost Sharing Plan Variation","78.21%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$0","$0","$3,750","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$0","$0","$1,000","$2,000","$0","$0","$1,560","$150","$0","$200","$990","$80","15"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380004","BlueChoice Young Adult $6,350","10207VA038",,"VAN001","VAS001","VAF004","New","HMO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213136729223",,,"0","3","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7CRXCVCN7AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","10%",,,,"$0","$0","$6,350","$12,700","$6,350","$0","$0","$150","$5,510","$0","$0","$80","16"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390001","BlueChoice HSA Bronze $4,000","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5ARXCVCN50N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390001-01","Standard Bronze On Exchange Plan","60.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$0","$0","$4,000","$8,000","$4,000","$0","$990","$150","$4,000","$30","$260","$80","17"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390001","BlueChoice HSA Bronze $4,000","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5ARXCVCN50N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","18"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390001","BlueChoice HSA Bronze $4,000","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5ARXCVCN50N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390001-03","Limited Cost Sharing Plan Variation","60.10%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$0","$0","$4,000","$8,000","$4,000","$0","$990","$150","$4,000","$30","$260","$80","19"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390002","BlueChoice HSA Bronze $6,000","10207VA039",,"VAN001","VAS001","VAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5CRXCVCN51N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390002-01","Standard Bronze On Exchange Plan","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$0","$0","$6,000","$12,000","$6,000","$0","$0","$150","$5,410","$0","$0","$80","20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020005","Select Med Preference Silver 1000","68781UT002",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020006-01","Standard Gold On Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"50"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"51"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030001-00","Standard Gold Off Exchange Plan","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"64"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030001","Select Care Preference Gold 250","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030001-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030001-03","Limited Cost Sharing Plan Variation","80.30%","0.804468274116516","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"67"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010004-00","Standard Gold Off Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030007-01","Standard Gold On Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"37"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"71"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010019","Select Value Millennial 6350 (Catastrophic Plan)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"92"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-00","Standard Silver Off Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-01","Standard Silver On Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"34"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-03","Limited Cost Sharing Plan Variation","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-04","73% AV Level Silver Plan","73.84%","0.738483309745789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,300","$6,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020006","Select Med Preference Gold 1000","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020006-03","Limited Cost Sharing Plan Variation","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"52"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"55"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-03","Limited Cost Sharing Plan Variation","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"56"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020008","Select Med Preference Silver 2500","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020008-04","73% AV Level Silver Plan","73.92%","0.738673806190491","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"57"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"60"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"61"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"22"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020004-03","Limited Cost Sharing Plan Variation","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-00","Standard Silver Off Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 5350 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020011-01","Standard Bronze On Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"23"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0120010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0120010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-06","94% AV Level Silver Plan",,"0.932928681373596","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"42"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-03","Limited Cost Sharing Plan Variation",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"62"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0020010","Select Med Preference Bronze 5000","68781UT002",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"72"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"73"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"74"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"75"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030005","Select Care Preference Silver 1000","68781UT003",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"76"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030006-00","Standard Gold Off Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"79"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030006-01","Standard Gold On Exchange Plan","78.20%","0.783298194408417","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,900","$5,800",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"80"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030006","Select Care Preference Gold 1000","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030006-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030006-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"81"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010004-01","Standard Gold On Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010004","Select Value Preference Gold 500 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-03","Limited Cost Sharing Plan Variation","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-04","73% AV Level Silver Plan","72.51%","0.727417528629303","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-03","Limited Cost Sharing Plan Variation","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-04","73% AV Level Silver Plan","72.51%","0.727417528629303","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-04","73% AV Level Silver Plan","73.84%","0.738483309745789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,300","$6,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-05","87% AV Level Silver Plan","87.27%","0.868025183677673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"28"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010018-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"29"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-01","Standard Silver On Exchange Plan","69.30%","0.689096033573151","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"84"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"85"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"88"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030008","Select Care Preference Silver 2500","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030008-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030008-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"89"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"90"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","1","68781","UT","Individual","No","87-0409820","68781UT0030010","Select Care Preference Bronze 5000","68781UT003",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"91"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010002-00","Standard Gold Off Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010002-01","Standard Gold On Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010002","Select Value Preference Gold 250 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010002-03","Limited Cost Sharing Plan Variation","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"38"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-03","Limited Cost Sharing Plan Variation","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"83"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","2","68809","UT","Individual","Yes","91-1857813","68809UT0010002","Smile for Kids PLUS Low Plan","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","3","68809","UT","Individual","Yes","91-1857813","68809UT0010003","PPO Family Plan with EHB","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010003-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","3","68809","UT","Individual","Yes","91-1857813","68809UT0010003","PPO Family Plan with EHB","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010003-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","3","68809","UT","Individual","Yes","91-1857813","68809UT0010004","PLUS Family Plan with EHB","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","3","68809","UT","Individual","Yes","91-1857813","68809UT0010004","PLUS Family Plan with EHB","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","4","68809","UT","Individual","Yes","91-1857813","68809UT0010005","PPO Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exceptions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010005-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"64"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-03","Limited Cost Sharing Plan Variation",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"65"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120010","Select Value Preference Benchmark Bronze 5000","68781UT012",,"UTN003","UTS003","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0120010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010007-00","Standard Gold Off Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010007-01","Standard Gold On Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0010007","Select Value Preference Gold 1000 w/no deductible for office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020002","Select Med Preference Gold 250 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020002-03","Limited Cost Sharing Plan Variation","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020004-00","Standard Gold Off Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020004","Select Med Preference Gold 500 w/no deductible for office visits","68781UT002",,"UTN003","UTS003","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020004-01","Standard Gold On Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020007-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"26"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0020007","Select Med Preference Gold 1000 w/no deductible for office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020007-03","Limited Cost Sharing Plan Variation","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/office deductible waiver","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030002-00","Standard Gold Off Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/office deductible waiver","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030002-01","Standard Gold On Exchange Plan","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/office deductible waiver","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"30"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030002","Select Care Preference Gold 250 w/office deductible waiver","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030002-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030002-03","Limited Cost Sharing Plan Variation","81.00%","0.811156451702118","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030004-00","Standard Gold Off Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030004-01","Standard Gold On Exchange Plan","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030004-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"34"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030004","Select Care Preference Gold 500 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF013","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030004-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030004-03","Limited Cost Sharing Plan Variation","79.40%","0.794067025184631","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"35"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030007-00","Standard Gold Off Exchange Plan","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","2","68781","UT","Individual","No","87-0409820","68781UT0030007","Select Care Preference Gold 1000 w/no deductible for office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Gold","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030007-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030007-03","Limited Cost Sharing Plan Variation","81.80%","0.818034648895264","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"39"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010009","Select Value Preference Silver 2500 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010009-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 5350 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010011-00","Standard Bronze Off Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-00","Standard Silver Off Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-01","Standard Silver On Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"26"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"27"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020016-01","Standard Bronze On Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"48"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"49"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-01","Standard Silver On Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"70"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 6350 (Catastrophic Plan)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"93"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"48"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0130010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"60"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0010011","Select Value Preference Bronze 5350 w/4 deductible-free office visits","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010011-03","Limited Cost Sharing Plan Variation","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-00","Standard Silver Off Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-01","Standard Silver On Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-04","73% AV Level Silver Plan","72.51%","0.727417528629303","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020009","Select Med Preference Silver 2500 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020009-05","87% AV Level Silver Plan","87.01%","0.870029091835022","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0020011","Select Med Preference Bronze 5350 w/4 deductible-free office visits","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020011-03","Limited Cost Sharing Plan Variation","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"25"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-00","Standard Silver Off Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-01","Standard Silver On Exchange Plan","68.30%","0.712623178958893","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030009","Select Care Preference Silver 2500 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030009-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030009-06","94% AV Level Silver Plan","94.70%","0.946996092796326","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 5350 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030011-00","Standard Bronze Off Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 5350 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030011-01","Standard Bronze On Exchange Plan","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 5350 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030011-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"35"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-06","94% AV Level Silver Plan",,"0.935191214084625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"35"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020018-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"58"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020018-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"59"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"82"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","3","68781","UT","Individual","No","87-0409820","68781UT0030011","Select Care Preference Bronze 5350 w/4 deductible-free office visits","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","4","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030011-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030011-03","Limited Cost Sharing Plan Variation","61.40%","0.616967439651489","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,350","$10,700","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"36"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-00","Standard Silver Off Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-01","Standard Silver On Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-03","Limited Cost Sharing Plan Variation","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-04","73% AV Level Silver Plan","73.84%","0.738483309745789","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,300","$6,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0010012","Select Value Preference Silver 3800 Copay Plan","68781UT001",,"UTN003","UTS003","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010012-05","87% AV Level Silver Plan","87.27%","0.868025183677673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-03","Limited Cost Sharing Plan Variation","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0020012","Select Med Preference Silver 3800 Copay Plan","68781UT002",,"UTN002","UTS002","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020012-06","94% AV Level Silver Plan","94.68%","0.93706750869751","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-00","Standard Silver Off Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-01","Standard Silver On Exchange Plan","71.60%","0.718337893486023","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,800","$7,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"27"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"28"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-05","87% AV Level Silver Plan","87.27%","0.868025183677673","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","4","68781","UT","Individual","No","87-0409820","68781UT0030012","Select Care Preference Silver 3800 (Copay Plan)","68781UT003",,"UTN001","UTS001","UTF011","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"5","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030012-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030012-06","94% AV Level Silver Plan","94.68%","0.93706750869751","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-04","73% AV Level Silver Plan",,"0.734175145626068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010014","Select Value HealthSave Silver 1500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010014-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-01","Standard Silver On Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"13"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-03","Limited Cost Sharing Plan Variation",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010015","Select Value HealthSave Silver 2000 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010015-04","73% AV Level Silver Plan",,"0.73095965385437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010016-00","Standard Bronze Off Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010016-01","Standard Bronze On Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010016","Select Value HealthSave Bronze 3500 (HSA Qualified)","68781UT001",,"UTN003","UTS003","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010016-03","Limited Cost Sharing Plan Variation",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"23"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010017","Select Value HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"24"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010018","Select Value HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"31"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-03","Limited Cost Sharing Plan Variation",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"36"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-04","73% AV Level Silver Plan",,"0.734175145626068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"44"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390002","BlueChoice HSA Bronze $6,000","10207VA039",,"VAN001","VAS001","VAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5CRXCVCN51N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","21"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390002","BlueChoice HSA Bronze $6,000","10207VA039",,"VAN001","VAS001","VAF004","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996232897353987",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN5CRXCVCN51N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390002-03","Limited Cost Sharing Plan Variation","59.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$0","$0","$6,000","$12,000",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","0%",,,,"$0","$0","$6,000","$12,000","$6,000","$0","$0","$150","$5,410","$0","$0","$80","22"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-01","Standard Silver On Exchange Plan","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$0","$0","$1,300","$2,600","$1,300","$0","$1,020","$150","$1,300","$150","$700","$80","23"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-04","73% AV Level Silver Plan","72.64%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$0","$0","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$1,400","$2,800","20%",,,,"$0","$0","$1,400","$2,800","$0","$0","$520","$150","$0","$0","$140","$80","7"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380002","BlueChoice Gold $0","10207VA038",,"VAN001","VAS001","VAF005","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996210596120598",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7ARXXVCN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0380002-01","Standard Gold On Exchange Plan","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$0","$0","30%",,,,"$0","$0","$0","$0","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$1,560","$150","$0","$200","$990","$80","10"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380002","BlueChoice Gold $0","10207VA038",,"VAN001","VAS001","VAF005","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996210596120598",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7ARXXVCN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0380002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","11"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380002","BlueChoice Gold $0","10207VA038",,"VAN001","VAS001","VAF005","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996210596120598",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7ARXXVCN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0380002-03","Limited Cost Sharing Plan Variation","79.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$0","$0","30%",,,,"$0","$0","$0","$0","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$1,560","$150","$0","$200","$990","$80","12"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380003","BlueChoice Gold $1,000","10207VA038",,"VAN001","VAS001","VAF006","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996222588414248",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN7CRXCVCN7AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380003-01","Standard Gold On Exchange Plan","78.21%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,750","$7,500",,,"$0","$0","$3,750","$7,500",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"$0","$0","$1,000","$2,000","$0","$0","$1,560","$150","$0","$200","$990","$80","13"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","24"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","6","12028","VA","Individual","No","06-6033492","12028VA0010006","IH AdvantagePlus 5500 PD: MO","12028VA001",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010006-00","Standard Bronze Off Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","6","12028","VA","Individual","No","06-6033492","12028VA0010006","IH AdvantagePlus 5500 PD: MO","12028VA001",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010006-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","6","12028","VA","Individual","No","06-6033492","12028VA0010006","IH AdvantagePlus 5500 PD: MO","12028VA001",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","6","12028","VA","Individual","No","06-6033492","12028VA0010006","IH AdvantagePlus 5500 PD: MO","12028VA001",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010006-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-00","Standard Silver Off Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-01","Standard Silver On Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020014","Select Med HealthSave Silver 1500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020014-06","94% AV Level Silver Plan",,"0.935191214084625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"39"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-00","Standard Silver Off Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-01","Standard Silver On Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-04","73% AV Level Silver Plan",,"0.73095965385437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"45"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020015","Select Med HealthSave Silver 2000 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020015-06","94% AV Level Silver Plan",,"0.932928681373596","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"46"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020016-00","Standard Bronze Off Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"47"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020016","Select Med HealthSave Bronze 3500 (HSA Qualified)","68781UT002",,"UTN002","UTS002","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020016-03","Limited Cost Sharing Plan Variation",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"50"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"51"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"52"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"53"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-03","Limited Cost Sharing Plan Variation",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"54"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"55"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"56"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020017","Select Med HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020017-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"57"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"60"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020018","Select Med HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020018-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"61"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-00","Standard Silver Off Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"62"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-01","Standard Silver On Exchange Plan",,"0.712389051914215","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"63"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-04","73% AV Level Silver Plan",,"0.734175145626068","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"66"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"67"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030014","Select Care HealthSave Silver 1500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030014-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030014-06","94% AV Level Silver Plan",,"0.935191214084625","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,700","$3,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"68"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-00","Standard Silver Off Exchange Plan",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"69"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030019","Select Care Millennial 6350 (Catastrophic Plan)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"96"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-03","Limited Cost Sharing Plan Variation","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"75"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"76"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","33"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-03","Limited Cost Sharing Plan Variation","70.14%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$400","$800","0%",,,,"$0","$0","$400","$800",,,,,,,,,,,"$1,500","$20","$1,010","$150","$1,500","$430","$210","$80","34"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-04","73% AV Level Silver Plan","73.87%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$0","$0","$5,200","$10,400","$1,600","$3,200","20%",,,,"$3,500","$7,000","$5,100","$10,200","$400","$800","20%",,,,"$0","$0","$400","$800",,,,,,,,,,,"$0","$0","$520","$150","$0","$0","$270","$80","35"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-05","87% AV Level Silver Plan","87.82%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500","$0","$0","20%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$1,040","$150","$0","$100","$570","$80","36"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-06","94% AV Level Silver Plan","93.66%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500","$0","$0","10%",,,,"$100","$200","Not Applicable","Not Applicable","$0","$0","10%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$1,040","$150","$0","$50","$570","$80","37"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0410001","HealthyBlue Gold $1,500","10207VA041",,"VAN001","VAS001","VAF007","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99621477639142",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCNVBN7ARXXVBN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410001-01","Standard Gold On Exchange Plan","82.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$3,450","$6,900","$6,900","$13,800","$1,500","$3,000","0%",,,,"$2,500","$5,000","$4,000","$8,000","$400","$800","0%",,,,"$0","$0","$400","$800",,,,,,,,,,,"$1,500","$450","$0","$150","$1,500","$440","$0","$80","38"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0410001","HealthyBlue Gold $1,500","10207VA041",,"VAN001","VAS001","VAF007","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99621477639142",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCNVBN7ARXXVBN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","39"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0410001","HealthyBlue Gold $1,500","10207VA041",,"VAN001","VAS001","VAF007","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.99621477639142",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCNVBN7ARXXVBN70N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410001-03","Limited Cost Sharing Plan Variation","82.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,450","$6,900",,,"$3,450","$6,900","$6,900","$13,800","$1,500","$3,000","0%",,,,"$2,500","$5,000","$4,000","$8,000","$400","$800","0%",,,,"$0","$0","$400","$800",,,,,,,,,,,"$1,500","$450","$0","$150","$1,500","$440","$0","$80","40"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","2","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0440004","BlueChoice Advantage 90% / 70%","10207VA044",,"VAN001","VAS001","VAF003","New","POS","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997053685794693",,,"0","0","0","2014-01-01",,"Yes","All covered services","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BAVVB08DRXXVB08AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0440004-01","Standard Platinum On Exchange Plan","88.01%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"$3,500","$7,000","$6,000","$12,000","$0","$0","10%",,,,"$2,000","$4,000","$2,000","$4,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$1,000","$20","$1,010","$150","$1,000","$360","$360","$80","4"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","2","10207","VA","Individual","No","52-1358219","10207VA0410002","HealthyBlue Platinum $0","10207VA041",,"VAN001","VAS001","VAF008","New","POS","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996228423342126",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCUVBN8ARXXVBN80N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410002-01","Standard Platinum On Exchange Plan","89.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$150","$0","$150","$0","$490","$0","$80","4"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-03","Limited Cost Sharing Plan Variation",,"0.685520052909851","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"72"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-04","73% AV Level Silver Plan",,"0.73095965385437","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,200","$2,400","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"73"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-05","87% AV Level Silver Plan",,"0.860099971294403","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$350","$875","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"74"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030015","Select Care HealthSave Silver 2000 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF003","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030015-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030015-06","94% AV Level Silver Plan",,"0.932928681373596","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$250","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"75"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030016-00","Standard Bronze Off Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"76"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030016-01","Standard Bronze On Exchange Plan",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"77"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030016-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"78"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030016","Select Care HealthSave Bronze 3500 (HSA Qualified)","68781UT003",,"UTN001","UTS001","UTF007","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030016-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030016-03","Limited Cost Sharing Plan Variation",,"0.619696199893951","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"79"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-00","Standard Silver Off Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"80"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-01","Standard Silver On Exchange Plan",,"0.688423931598663","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"81"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-04","73% AV Level Silver Plan",,"0.732454240322113","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,750","$5,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,750","$5,500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"84"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-05","87% AV Level Silver Plan",,"0.876513063907623","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"85"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030017","Select Care HealthSave Silver 3500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Silver","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030017-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030017-06","94% AV Level Silver Plan",,"0.932734072208405","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"86"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030018-00","Standard Bronze Off Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"87"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030018-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"88"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030018-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"89"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030018","Select Care HealthSave Bronze 5500 (HSA Qualified and no coinsurance after deductible)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Bronze","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030018-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030018-03","Limited Cost Sharing Plan Variation",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"90"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0010019","Select Value Millennial 6350 (Catastrophic Plan)","68781UT001",,"UTN003","UTS003","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0010019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0010019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"91"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0020019","Select Med Millennial 6350 (Catastrophic Plan)","68781UT002",,"UTN002","UTS002","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0020019-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"94"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","5","68781","UT","Individual","No","87-0409820","68781UT0030019","Select Care Millennial 6350 (Catastrophic Plan)","68781UT003",,"UTN001","UTS001","UTF004","New","HMO","Catastrophic","No","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.9882",,,"0","0","3","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030019-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0030019-00","Standard Catastrophic Off Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"95"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0120005","Select Value Preference Benchmark Silver 1000","68781UT012",,"UTN003","UTS003","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$44.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0020005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0120005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"42"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"43"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-04","73% AV Level Silver Plan","73.92%","0.738911926746368","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"46"
"2014","UT","71246","SERFF","3","2013-10-15 10:04:03","1","71246","UT","Individual","Yes","94-2761537","71246UT0010001","Delta Dental PPO Plan 70 for Children","71246UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.42",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,,,"71246UT0010001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","71246","SERFF","3","2013-10-15 10:04:03","1","71246","UT","Individual","Yes","94-2761537","71246UT0010002","Delta Dental PPO Plan 85 for Children","71246UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,,,"71246UT0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","71246","SERFF","3","2013-10-15 10:04:03","1","71246","UT","Individual","Yes","94-2761537","71246UT0010002","Delta Dental PPO Plan 85 for Children","71246UT001",,"UTN001","UTS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$11.17",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,,,"71246UT0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0550002","BlueChoice HMO Referral HSA/HRA $4,000","10207VA055",,"VAN001","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","Yes","All specialists require referral except covered services rendered by a contracting obstetrician/gynecologist; covered services rendered at contracting provider radiologist offices; covered services rendered by a contracting provider laboratory; and covered services rendered by a contracting provider ophthalmologist.",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997053685794693",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVC05ARXCVC05CN012014.pdf",,,"www.carefirst.com/acarx","10207VA0550002-01","Standard Bronze On Exchange Plan","61.18%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$0","$0","$4,000","$8,000","$4,000","$20","$660","$150","$4,000","$150","$60","$80","4"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-01","Standard Silver On Exchange Plan","68.85%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$2,000","$20","$1,010","$150","$2,000","$440","$190","$80","4"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0420002","BlueChoice HMO HSA/HRA $2,000","10207VA042",,"VAN001","VAS001","VAF003","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997053685794693",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVC06ARXCVC06CN012014.pdf",,,"www.carefirst.com/acarx","10207VA0420002-01","Standard Silver On Exchange Plan","70.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"$0","$0","$4,000","$8,000",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$4,000","$20","$660","$150","$4,000","$150","$60","$80","5"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","SHOP (Small Group)","No","52-1358219","10207VA0430003","BlueChoice HMO $1,000","10207VA043",,"VAN001","VAS001","VAF003","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.997053685794693",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVC07CRXCVC07AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0430003-01","Standard Gold On Exchange Plan","78.47%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$0","$0","$3,000","$6,000",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","20%",,,,"$0","$0","$1,000","$2,000","$1,000","$20","$1,010","$150","$1,000","$360","$360","$80","6"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0380001","BlueChoice Silver $2,000","10207VA038",,"VAN001","VAS001","VAF001","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231219760632",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHAVCN6ARXCVCN6AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0380001-03","Limited Cost Sharing Plan Variation","68.85%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"$0","$0","$2,000","$4,000","$2,000","$20","$1,010","$150","$2,000","$440","$190","$80","6"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130005","Select Med Preference Benchmark Silver 1000","68781UT013",,"UTN002","UTS002","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0030005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"47"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0130010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"61"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0130010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"62"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0130010","Select Med Preference Benchmark Bronze 5000","68781UT013",,"UTN002","UTS002","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$48.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0130010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0130010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"63"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-00","Standard Silver Off Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"72"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-01","Standard Silver On Exchange Plan","70.20%","0.683835566043854","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,800","$11,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,500","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"73"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"74"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-05","87% AV Level Silver Plan","86.57%","0.865749955177307","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$750","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$100","Not Applicable","15%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"77"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140005","Select Care Preference Benchmark Silver 1000","68781UT014",,"UTN001","UTS001","UTF008","New","HMO","Silver","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140005-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140005-06","94% AV Level Silver Plan","94.68%","0.946797907352448","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","Not Applicable","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"78"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140010-00","Standard Bronze Off Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"90"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140010-01","Standard Bronze On Exchange Plan","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"91"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140010-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"92"
"2014","UT","68781","SERFF","6","2014-03-18 09:48:59","9","68781","UT","Individual","No","87-0409820","68781UT0140010","Select Care Preference Benchmark Bronze 5000","68781UT014",,"UTN001","UTS001","UTF010","New","HMO","Bronze","Yes","Both","No","No",,"Abortions/Termination of Pregnancy (except to save the life of the mother or when caused by rape/incest); Acupuncture/Acupressure; Certain Allergy Tests; Bariatric Surgery; Birthing Centers/Home Childbirth; Certain Cancer Therapies; Complementary/Alternative Medicine; Complications of a Non-Covered Service; Custodial Care; Dental Anesthesia where criteria is not met; Exercise Equipment/Fitness Training; Experimental/Investigational Services (except for approved clinical trials); Refractive Eye Surgery; Food Supplements; Gender Reassignment Treatment and Surgery; Gene Therapy; Hearing Aids; Home Health Aides; Certain Immunizations; Certain Pain Management Services; Certain Prescription/Injectable Drugs and Specialty Medications; Reconstructive, Corrective, and Cosmetic Services; Vision Rehabilitation Therapy Services; Respite Care; Robot-Assisted Surgery; Sexual Dysfunction; Certain Specialty Services; Telephone/E-mail Consultations; Travel-Related Expenses;  computer-assisted interpretation of X-rays; Computer-assisted navigation for orthopedic procedures; Home A1C testing; Magnetic Source Imaging (MSI); Manipulation under anesthesia; Radiofrequency ablation for lateral epicondylitis; Virtual colonoscopy screening; and certain DME items.","$52.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Urgent and emergency care only","Yes","Urgent and emergency care only","No","selecthealth.org/sbc","selecthealth.org/ffmpayment/medical.aspx","http://reform.selecthealth.org/product-detail/?id=68781UT0140010-00","https://selecthealth.org/pharmacy/plans/Pages/home.aspx","68781UT0140010-03","Limited Cost Sharing Plan Variation","59.10%","0.588243365287781","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$5,000","$10,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","Not Applicable","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"93"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","1","68809","UT","Individual","Yes","91-1857813","68809UT0010001","Smile for Kids Low Plan","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","1","68809","UT","Individual","Yes","91-1857813","68809UT0010001","Smile for Kids Low Plan","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions.",,,,,"Allows Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","2","68809","UT","Individual","Yes","91-1857813","68809UT0010002","Smile for Kids PLUS Low Plan","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exclusions",,,,,"Allows Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","4","68809","UT","Individual","Yes","91-1857813","68809UT0010005","PPO Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exceptions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the usual, customary, and reasonable amount in each geographic area as determined by Premier Access using industry data.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010005-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","4","68809","UT","Individual","Yes","91-1857813","68809UT0010006","PLUS Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exceptions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","UT","68809","SERFF","3","2013-09-17 21:55:00","4","68809","UT","Individual","Yes","91-1857813","68809UT0010006","PLUS Family Plan with EHB PLUS","68809UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,"Please see the Schedule of Benefits for limitations and exceptions.",,,,,"Allows Adult and Child-Only",,,,"$12.63",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","The out of network benefit is limited to the Maximum Allowable Charge, which is equal to the negotiated fee schedule amount agreed to by participating providers.","Yes","www.premierlife.com/avenueh",,"www.premierlife.com/avenueh",,"68809UT0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","Not Applicable",,,,,"$100","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","UT","71246","SERFF","3","2013-10-15 10:04:03","1","71246","UT","Individual","Yes","94-2761537","71246UT0010001","Delta Dental PPO Plan 70 for Children","71246UT001",,"UTN001","UTS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$8.42",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,,,"71246UT0010001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-03","Limited Cost Sharing Plan Variation","69.60%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"$0","$0","$1,300","$2,600","$1,300","$0","$1,020","$150","$1,300","$150","$700","$80","25"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-04","73% AV Level Silver Plan","73.48%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$0","$0","$5,200","$10,400",,,,,,,,,,,,,,,,,,,,,"$900","$1,800","20%",,,,"$0","$0","$900","$1,800","$1,400","$0","$760","$150","$1,400","$150","$680","$80","26"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-05","87% AV Level Silver Plan","87.67%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","20%",,,,"$0","$0","$0","$0","$0","$0","$520","$150","$0","$0","$140","$80","27"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0390003","BlueChoice HSA Silver $1,300","10207VA039",,"VAN001","VAS001","VAF005","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996231760115452",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BHHVCN6ARXCVCN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0390003-06","94% AV Level Silver Plan","93.22%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$0","$0","$2,250","$4,500",,,,,,,,,,,,,,,,,,,,,"$0","$0","10%",,,,"$0","$0","$0","$0","$0","$0","$520","$150","$0","$300","$10","$80","28"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996220576298701",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN5ARXCVBN5AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0400001-01","Standard Bronze On Exchange Plan","61.34%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$6,350","$12,700","$11,850","$23,700","$5,500","$20","$360","$150","$5,410","$0","$0","$80","29"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996220576298701",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN5ARXCVBN5AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0400001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","30"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400001","BlueChoice Plus Bronze $5,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996220576298701",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN5ARXCVBN5AN012014.pdf",,,"www.carefirst.com/acarx","10207VA0400001-03","Limited Cost Sharing Plan Variation","61.34%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","20%",,,,"$6,350","$12,700","$11,850","$23,700","$5,500","$20","$360","$150","$5,410","$0","$0","$80","31"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","1","10207","VA","Individual","No","52-1358219","10207VA0400002","BlueChoice Plus Silver $2,500","10207VA040",,"VAN001","VAS001","VAF006","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996213465862028",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BTPVBN6ARXXVBN60N012014.pdf",,,"www.carefirst.com/acarx","10207VA0400002-01","Standard Silver On Exchange Plan","70.14%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$0","$0","$6,350","$12,700","$2,500","$5,000","20%",,,,"$5,000","$10,000","$7,500","$15,000","$400","$800","0%",,,,"$0","$0","$400","$800",,,,,,,,,,,"$1,500","$20","$1,010","$150","$1,500","$430","$210","$80","32"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","2","10207","VA","Individual","No","52-1358219","10207VA0410002","HealthyBlue Platinum $0","10207VA041",,"VAN001","VAS001","VAF008","New","POS","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996228423342126",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCUVBN8ARXXVBN80N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","VA","10207","SERFF","9","2014-01-22 11:51:12","2","10207","VA","Individual","No","52-1358219","10207VA0410002","HealthyBlue Platinum $0","10207VA041",,"VAN001","VAS001","VAF008","New","POS","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996228423342126",,"$200","0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","All covered services","Yes","http://content.carefirst.com/sbc/HCUVBN8ARXXVBN80N012014.pdf",,,"www.carefirst.com/acarx","10207VA0410002-03","Limited Cost Sharing Plan Variation","89.80%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$2,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$150","$0","$150","$0","$490","$0","$80","6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","1","12028","VA","Individual","No","06-6033492","12028VA0010002","IH Advantage 6350: MO","12028VA001",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","1","12028","VA","Individual","No","06-6033492","12028VA0010002","IH Advantage 6350: MO","12028VA001",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","1","12028","VA","Individual","No","06-6033492","12028VA0010002","IH Advantage 6350: MO","12028VA001",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","2","12028","VA","Individual","No","06-6033492","12028VA0010001","IH Advantage 6350","12028VA001",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010001-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","2","12028","VA","Individual","No","06-6033492","12028VA0010001","IH Advantage 6350","12028VA001",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","2","12028","VA","Individual","No","06-6033492","12028VA0010001","IH Advantage 6350","12028VA001",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010001-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","5","12028","VA","Individual","No","06-6033492","12028VA0010005","IH AdvantagePlus 5500 PD","12028VA001",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010005-00","Standard Bronze Off Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","5","12028","VA","Individual","No","06-6033492","12028VA0010005","IH AdvantagePlus 5500 PD","12028VA001",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010005-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","5","12028","VA","Individual","No","06-6033492","12028VA0010005","IH AdvantagePlus 5500 PD","12028VA001",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","5","12028","VA","Individual","No","06-6033492","12028VA0010005","IH AdvantagePlus 5500 PD","12028VA001",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010005-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-03","Limited Cost Sharing Plan Variation","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","7","12028","VA","Individual","No","06-6033492","12028VA0010013","IH Classic 3500 PD","12028VA001",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010013-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-00","Standard Silver Off Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-01","Standard Silver On Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-03","Limited Cost Sharing Plan Variation","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","8","12028","VA","Individual","No","06-6033492","12028VA0010014","IH Classic 3500 PD: MO","12028VA001",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010014-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-01","Standard Silver On Exchange Plan","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-03","Limited Cost Sharing Plan Variation","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-04","73% AV Level Silver Plan","73.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","9","12028","VA","Individual","No","06-6033492","12028VA0010015","IH Classic 5000","12028VA001",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010015-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-01","Standard Silver On Exchange Plan","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-03","Limited Cost Sharing Plan Variation","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-04","73% AV Level Silver Plan","73.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","10","12028","VA","Individual","No","06-6033492","12028VA0010016","IH Classic 5000: MO","12028VA001",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010016-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","13","12028","VA","Individual","No","06-6033492","12028VA0010011","IH Premier 2000 PD","12028VA001",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010011-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","13","12028","VA","Individual","No","06-6033492","12028VA0010011","IH Premier 2000 PD","12028VA001",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","13","12028","VA","Individual","No","06-6033492","12028VA0010011","IH Premier 2000 PD","12028VA001",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010011-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","14","12028","VA","Individual","No","06-6033492","12028VA0010012","IH Premier 2000 PD: MO","12028VA001",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010012-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","14","12028","VA","Individual","No","06-6033492","12028VA0010012","IH Premier 2000 PD: MO","12028VA001",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","14","12028","VA","Individual","No","06-6033492","12028VA0010012","IH Premier 2000 PD: MO","12028VA001",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010012-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","15","12028","VA","Individual","No","06-6033492","12028VA0010007","IH Basic","12028VA001",,"VAN001","VAS001","VAF007","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","12028","SERFF","4","2013-09-19 10:34:04","16","12028","VA","Individual","No","06-6033492","12028VA0010008","IH Basic: MO","12028VA001",,"VAN001","VAS001","VAF008","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997061106327355",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","http://www.innovation-health.com/individual-families/exchange/","12028VA0010008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","31319","SERFF","1","2013-08-01 21:15:43","1","31319","VA","SHOP (Small Group)","Yes","54-0844477","31319VA0020006","Delta Dental PPO Plus Premier Exchange Certified Family Plan","31319VA002",,"VAN001","VAS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.43",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,,,,"31319VA0020006-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","68%","32%","$700","$1,400","$700","$1,400","$700","$1,400","$700","$1,400",,,,,,,,,,,,,,,,,"$50","$100",,"$50","$100",,"$50","$100","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0210001","Guardian Pediatric Essentials","42808VA021",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0210001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","2","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0220001","Guardian Family Advantage Plus","42808VA022",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0220001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","2","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0220001","Guardian Family Advantage Plus","42808VA022",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0220001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","3","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0240001","Guardian Family Essentials Plus","42808VA024",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0240001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","3","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0240001","Guardian Family Essentials Plus","42808VA024",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0240001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","4","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0230001","Guardian Family Advantage","42808VA023",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0230001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","4","88380","VA","Individual","No","54-1356687","88380VA0720001","Anthem HealthKeepers Bronze DirectAccess - caam","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUL","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720001-01","Standard Bronze On Exchange Plan","60.00%","0.600980877876282","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","25%","$5,500","$11,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1240001","Vantage Equity 2500/80/4500/RxLow","20507VA124","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1240001.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1240001-01","Standard Silver On Exchange Plan",,"0.680282711982727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-01","Standard Silver On Exchange Plan",,"0.682460963726044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1240002","Vantage Equity 3750/70/6250 RxLow","20507VA124","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1240002.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1240002-01","Standard Bronze On Exchange Plan",,"0.616678059101105","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-03","Limited Cost Sharing Plan Variation",,"0.682460963726044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230004","Vantage 2500/70/6250 RxLow","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230004.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230004-01","Standard Bronze On Exchange Plan","61.15%","0.611360847949982","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1240004","Vantage Equity 3750/70/6250 RxLow MO","20507VA124","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.820514789449541",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1240004.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1240004-01","Standard Bronze On Exchange Plan",,"0.616678059101105","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190001","Vantage 3500 60%","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190001-03","Limited Cost Sharing Plan Variation","61.77%","0.619447410106659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230009","Vantage 2500/70/6250 RxLow MO","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.821735165595022",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230009.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230009-01","Standard Bronze On Exchange Plan","61.15%","0.611360847949982","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","5","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0100001","Smile for Health Child C60A60","13756VA010",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a60-ppo.pdf",,,,"13756VA0100001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-00","Standard Silver Off Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-01","Standard Silver On Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-03","Limited Cost Sharing Plan Variation","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","8","38234","VA","Individual","No","06-6033492","38234VA0060014","Aetna Classic 3500 PD: MO","38234VA006",,"VAN001","VAS001","VAF014","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060014-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-01","Standard Silver On Exchange Plan","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-03","Limited Cost Sharing Plan Variation","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-04","73% AV Level Silver Plan","73.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230003","Vantage 2000/80/6250 RxLow","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230003.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230003-01","Standard Silver On Exchange Plan",,"0.681601643562317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180001","Vantage Equity 3750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180001-01","Standard Bronze On Exchange Plan",,"0.601321935653687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180001","Vantage Equity 3750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","5","13756","VA","Individual","Yes","23-0307623","13756VA0180001","Smile for Health Child C80","13756VA018",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.04",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-idental",,,"13756VA0180001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","5","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0100001","Smile for Health Child C60A60","13756VA010",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$25.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a60-ppo.pdf",,,,"13756VA0100001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","3","13756","VA","Individual","Yes","23-0307623","13756VA0020002","Smile for Health Family C60A60","13756VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","4","13756","VA","Individual","Yes","23-0307623","13756VA0040001","Smile for Health Child C60A50","13756VA004",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-idental",,,"13756VA0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","4","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0200001","Smile for Health Child C80","13756VA020",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0200001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","9","38234","VA","Individual","No","06-6033492","38234VA0060015","Aetna Classic 5000","38234VA006",,"VAN001","VAS001","VAF015","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060015-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-01","Standard Silver On Exchange Plan","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240001","Anthem Dental Family","16064VA124",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1240001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1270001","Anthem Dental Family","16064VA127",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1270001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240001","Anthem Dental Family","16064VA124",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1240001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1270001","Anthem Dental Family","16064VA127",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1270001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240002","Anthem Dental Family Enhanced","16064VA124",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1240002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1270050","Anthem Dental Family Enhanced","16064VA127",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1270050-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1270050","Anthem Dental Family Enhanced","16064VA127",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1270050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1240002","Anthem Dental Family Enhanced","16064VA124",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1240002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300001","Anthem Dental Family","16064VA130",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1300001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1330001","Anthem Dental Family","16064VA133",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1330001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230005","Vantage 3000/70/6250 RxLow","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230005.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230005-01","Standard Bronze On Exchange Plan","60.15%","0.601350545883179","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-04","73% AV Level Silver Plan",,"0.736405551433563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-05","87% AV Level Silver Plan",,"0.862978219985962","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230006","Vantage 1000/90/6250  RxLow MO","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.830763827378154",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230006.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230006-01","Standard Gold On Exchange Plan","78.70%","0.782188296318054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230007","Vantage 1500/80/6250  RxLow MO","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.827491818071284",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230007.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230007-01","Standard Silver On Exchange Plan","71.17%","0.7105433344841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170002","Vantage FourSight 3500 80%","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170002-06","94% AV Level Silver Plan",,"0.932743549346924","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190001","Vantage 3500 60%","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190001-01","Standard Bronze On Exchange Plan","61.77%","0.619447410106659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230008","Vantage 2000/80/6250 RxLow MO","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","No","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.826004533742941",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230008.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230008-01","Standard Silver On Exchange Plan",,"0.681601643562317","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,000","$4,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1240003","Vantage Equity 2500/80/4500 RxLow MO","20507VA124","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","No","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.823644938575973",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1240003.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1240003-01","Standard Silver On Exchange Plan",,"0.680282711982727","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190001","Vantage 3500 60%","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","Individual","Yes","23-0307623","13756VA0070001","Smile for Health Child C80A80","13756VA007",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.04",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0090001","Smile for Health Child C60A70","13756VA009",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a70-ppo.pdf",,,,"13756VA0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0090001","Smile for Health Child C60A70","13756VA009",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a70-ppo.pdf",,,,"13756VA0090001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","1","13756","VA","Individual","Yes","23-0307623","13756VA0170001","Smile for Health Child C60","13756VA017",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-idental",,,"13756VA0170001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","1","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0150001","Smile for Health Child C80A80","13756VA015",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c80a80-ppo.pdf",,,,"13756VA0150001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","1","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0150001","Smile for Health Child C80A80","13756VA015",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c80a80-ppo.pdf",,,,"13756VA0150001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","1","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0150002","Smile for Health Family C80A80","13756VA015",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c80a80-ppo.pdf",,,,"13756VA0150002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","1","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0150002","Smile for Health Family C80A80","13756VA015",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c80a80-ppo.pdf",,,,"13756VA0150002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","Individual","Yes","23-0307623","13756VA0010002","Smile for Health Family C60A70","13756VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0120001","Smile for Health Child C60A50","13756VA012",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a50-ppo.pdf",,,,"13756VA0120001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","Individual","Yes","23-0307623","13756VA0010002","Smile for Health Family C60A70","13756VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0120001","Smile for Health Child C60A50","13756VA012",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-child-c60a50-ppo.pdf",,,,"13756VA0120001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","Individual","Yes","23-0307623","13756VA0010001","Smile for Health Child C60A70","13756VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0120002","Smile for Health Family C60A50","13756VA012",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a50-ppo.pdf",,,,"13756VA0120002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","Individual","Yes","23-0307623","13756VA0010001","Smile for Health Child C60A70","13756VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c60a70-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","2","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0120002","Smile for Health Family C60A50","13756VA012",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a50-ppo.pdf",,,,"13756VA0120002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","3","13756","VA","Individual","Yes","23-0307623","13756VA0020001","Smile for Health Child C60A60","13756VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","3","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0190001","Smile for Health Child C60","13756VA019",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0190001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","3","13756","VA","Individual","Yes","23-0307623","13756VA0020001","Smile for Health Child C60A60","13756VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","3","13756","VA","Individual","Yes","23-0307623","13756VA0020002","Smile for Health Family C60A60","13756VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c60a60-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","4","13756","VA","Individual","Yes","23-0307623","13756VA0040002","Smile For Health Family C60A50","13756VA004",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$41.65",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes",,"https://secure.ucci.com/ducdws/individual.xhtml?content=enrollment-payment-va-idental",,,"13756VA0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","5","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0100002","Smile for Health Family C60A60","13756VA010",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a60-ppo.pdf",,,,"13756VA0100002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","5","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0100002","Smile for Health Family C60A60","13756VA010",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$25.09",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a60-ppo.pdf",,,,"13756VA0100002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","Individual","Yes","23-0307623","13756VA0070001","Smile for Health Child C80A80","13756VA007",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.04",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-child-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","Individual","Yes","23-0307623","13756VA0070002","Smile for Health Family C80A80","13756VA007",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.04",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0090002","Smile for Health Family C60A70","13756VA009",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a70-ppo.pdf",,,,"13756VA0090002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","Individual","Yes","23-0307623","13756VA0070002","Smile for Health Family C80A80","13756VA007",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.04",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-indv-family-c80a80-ppo.pdf","https://ssoprod.healthplan.com/sp/ACS.saml2�",,,"13756VA0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","6","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0090002","Smile for Health Family C60A70","13756VA009",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes","https://secure.ucci.com/docs/benefits-summary-va-grp-family-c60a70-ppo.pdf",,,,"13756VA0090002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","7","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0130001","Smile for Health Child C80A70","13756VA013",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0130001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","7","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0130002","Smile for Health Family C80A70","13756VA013",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0130002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","8","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0160001","Smile for Health Child C80A50","13756VA016",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0160001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","8","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0160002","Smile for Health Family C80A50","13756VA016",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0160002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","9","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0140001","Smile for Health Child C80A60","13756VA014",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0140001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","9","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0140002","Smile for Health Family C80A60","13756VA014",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$37.19",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0140002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","10","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0110001","Smile for Health Child C60A80","13756VA011",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0110001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","13756","SERFF","5","2014-01-22 11:51:12","10","13756","VA","SHOP (Small Group)","Yes","86-0307623","13756VA0110002","Smile for Health Family C60A80","13756VA011",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$31.34",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Coverage is the same as in-service area.","Yes",,,,,"13756VA0110002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180001","Vantage Equity 3750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180001-03","Limited Cost Sharing Plan Variation",,"0.601321935653687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180002","Vantage Equity 4250","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180002-01","Standard Bronze On Exchange Plan",,"0.592692196369171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"19"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180002","Vantage Equity 4250","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180002-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"20"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180002","Vantage Equity 4250","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180002-03","Limited Cost Sharing Plan Variation",,"0.592692196369171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"21"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180003","Vantage Equity 4750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180003-01","Standard Bronze On Exchange Plan",,"0.58322811126709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"22"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180003","Vantage Equity 4750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"23"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180003","Vantage Equity 4750","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180003-03","Limited Cost Sharing Plan Variation",,"0.58322811126709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"24"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190002","Vantage 6350","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190002.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190002-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"25"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170003","Vantage FourSight 1000 MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.201005889951733",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170003-01","Standard Gold On Exchange Plan",,"0.809399127960205","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"26"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170003","Vantage FourSight 1000 MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.201005889951733",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"27"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170003","Vantage FourSight 1000 MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.201005889951733",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170003-03","Limited Cost Sharing Plan Variation",,"0.809399127960205","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"28"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-01","Standard Silver On Exchange Plan",,"0.682460963726044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"29"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"30"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-03","Limited Cost Sharing Plan Variation",,"0.682460963726044","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"31"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1220001","Anthem Dental Pediatric","16064VA122",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1220001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1250001","Anthem Dental Pediatric","16064VA125",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1250001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1250001","Anthem Dental Pediatric","16064VA125",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1250001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1220001","Anthem Dental Pediatric","16064VA122",,"VAN001","VAS001",,"New","PPO","Low",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1220001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1220002","Anthem Dental Pediatric Enhanced","16064VA122",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1220002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1250050","Anthem Dental Pediatric Enhanced","16064VA125",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1250050-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1250050","Anthem Dental Pediatric Enhanced","16064VA125",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1250050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1220002","Anthem Dental Pediatric Enhanced","16064VA122",,"VAN001","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1220002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1280001","Anthem Dental Pediatric","16064VA128",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1280001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1310001","Anthem Dental Pediatric","16064VA131",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1310001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1310001","Anthem Dental Pediatric","16064VA131",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1310001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1280001","Anthem Dental Pediatric","16064VA128",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$22.19",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209937.pdf",,,,"16064VA1280001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1280002","Anthem Dental Pediatric Enhanced","16064VA128",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1280002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1310050","Anthem Dental Pediatric Enhanced","16064VA131",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1310050-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1280002","Anthem Dental Pediatric Enhanced","16064VA128",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1280002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","1","16064","VA","Individual","Yes","54-0357120","16064VA1310050","Anthem Dental Pediatric Enhanced","16064VA131",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Child-Only",,,,"$24.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e213350.pdf",,,,"16064VA1310050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","6","38234","VA","Individual","No","06-6033492","38234VA0060006","Aetna AdvantagePlus 5500 PD: MO","38234VA006",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060006-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-00","Standard Silver Off Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-01","Standard Silver On Exchange Plan","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-03","Limited Cost Sharing Plan Variation","69.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-04","73% AV Level Silver Plan","72.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","7","38234","VA","Individual","No","06-6033492","38234VA0060013","Aetna Classic 3500 PD","38234VA006",,"VAN001","VAS001","VAF013","New","PPO","Silver","Yes","Both","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060013-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$7,000","$14,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300001","Anthem Dental Family","16064VA130",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1300001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1330001","Anthem Dental Family","16064VA133",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209935.pdf",,,,"16064VA1330001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300002","Anthem Dental Family Enhanced","16064VA130",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1300002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1330050","Anthem Dental Family Enhanced","16064VA133",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1330050-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","SHOP (Small Group)","Yes","54-0357120","16064VA1300002","Anthem Dental Family Enhanced","16064VA130",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1300002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","16064","SERFF","6","2014-06-23 15:22:56","2","16064","VA","Individual","Yes","54-0357120","16064VA1330050","Anthem Dental Family Enhanced","16064VA133",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.80",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Out of Country covered services are reimbursed as out-of-network benefits.","Yes","If a member does not use a network dentist, services will be reimbursed at the out-of-network level.","Yes","http://www.anthem.com/agent/va/f0/s0/t0/pw_e209936.pdf",,,,"16064VA1330050-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230001","Vantage 1000/90/6250 RxLow","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230001.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230001-01","Standard Gold On Exchange Plan","78.70%","0.782188296318054","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170001"," Vantage FourSight 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170001-01","Standard Gold On Exchange Plan",,"0.809399127960205","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230002","Vantage 1500/80/6250 RxLow","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230002.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG1.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230002-01","Standard Silver On Exchange Plan","71.17%","0.7105433344841","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170001"," Vantage FourSight 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170001"," Vantage FourSight 1000","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170001.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP1.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170001-03","Limited Cost Sharing Plan Variation",,"0.809399127960205","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$250","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","SHOP (Small Group)","No","54-1283337","20507VA1230010","Vantage 3000/70/6250 RxLow MO","20507VA123","7487657612","VAN001","VAS002","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.820084178753403",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1230010.pdf",,"http://public.optimahealth.com/exchangesbc/HIXBrochureSG2.pdf","www.optimahealth.com/HIXSGformulary","20507VA1230010-01","Standard Bronze On Exchange Plan","60.15%","0.601350545883179","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-04","73% AV Level Silver Plan",,"0.736405551433563","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,000","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"32"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-05","87% AV Level Silver Plan",,"0.862978219985962","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,100","$8,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"33"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1170004","Vantage FourSight 3500 80%_MO","20507VA117","7487657612","VAN001","VAS001","VAF001","New","HMO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192974243701984",,,"0","0","4","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1170004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1170004-06","94% AV Level Silver Plan",,"0.932743549346924","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$150","$150","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"34"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190003","Vantage 3500_60%_MO","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.199452175386644",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190003-01","Standard Bronze On Exchange Plan","61.77%","0.619447410106659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"35"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190003","Vantage 3500_60%_MO","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.199452175386644",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"36"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190003","Vantage 3500_60%_MO","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.199452175386644",,,"0","0","2","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190003.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190003-03","Limited Cost Sharing Plan Variation","61.77%","0.619447410106659","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","40%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"37"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180004","Vantage Equity 3750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.197993776947379",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180004-01","Standard Bronze On Exchange Plan",,"0.601321935653687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"38"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180004","Vantage Equity 3750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.197993776947379",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"39"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180004","Vantage Equity 3750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.197993776947379",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180004-03","Limited Cost Sharing Plan Variation",,"0.601321935653687","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"40"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180005","Vantage Equity 4250_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.195487058122087",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180005.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180005-01","Standard Bronze On Exchange Plan",,"0.592692196369171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"41"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180005","Vantage Equity 4250_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.195487058122087",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180005.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"42"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180005","Vantage Equity 4250_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.195487058122087",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180005.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180005-03","Limited Cost Sharing Plan Variation",,"0.592692196369171","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,250","$8,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"43"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180006","Vantage Equity 4750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192964620364548",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180006.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180006-01","Standard Bronze On Exchange Plan",,"0.58322811126709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"44"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180006","Vantage Equity 4750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192964620364548",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180006.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180006-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"45"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1180006","Vantage Equity 4750_MO","20507VA118","7487657612","VAN001","VAS001","VAF001","New","HMO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.192964620364548",,,"0","0","0","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1180006.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1180006-03","Limited Cost Sharing Plan Variation",,"0.58322811126709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,250","$12,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,750","$9,500","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"46"
"2014","VA","20507","SERFF","7","2014-03-13 08:40:27","1","20507","VA","Individual","No","54-1283337","20507VA1190004","Vantage 6350_MO","20507VA119","7487657612","VAN001","VAS001","VAF001","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.166929105473407",,,"0","0","3","2014-01-01",,"Yes","emergency only","Yes","emergency only","No","http://public.optimahealth.com/exchangesbc/HIXSBC20507VA1190004.pdf","http://optima.benefitalign.com/Optima/Application/FFMInitialPayment","http://public.optimahealth.com/exchangesbc/HIXBrochureIFP2.pdf","www.optimahealth.com/HIXIFPformulary","20507VA1190004-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"47"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","SHOP (Small Group)","Yes","47-0397286","24832VA0030001","Renaissance Group Dental PPO, EHB Certified","24832VA003",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.40",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0030001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","Individual","Yes","47-0397286","24832VA0010001","Delta Dental Individual PPO, EHB Certified","24832VA001",,"VAN002","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.65",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0010001-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","SHOP (Small Group)","Yes","47-0397286","24832VA0030002","Renaissance Group Dental PPO, EHB Certified","24832VA003",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.75",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0030002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","Individual","Yes","47-0397286","24832VA0010002","Delta Dental Individual PPO, EHB Certified","24832VA001",,"VAN002","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.53",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0010002-00","Standard Low Off Exchange Plan","70.00%",,,,"Yes","25%","75%","$700","$1,400","$700","$1,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,"$0","$0",,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","Individual","Yes","47-0397286","24832VA0020001","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$34.28",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0020001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","24832","SERFF","1","2013-08-01 21:15:43","1","24832","VA","Individual","Yes","47-0397286","24832VA0020002","Renaissance Individual Dental PPO, EHB Certified","24832VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$28.05",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency Services Only","Yes","Same Benefit Level","Yes",,,,,"24832VA0020002-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","$0",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","31319","SERFF","1","2013-08-01 21:15:43","1","31319","VA","SHOP (Small Group)","Yes","54-0844477","31319VA0020005","Delta Dental PPO Plus Premier Exchange Certified Family Plan","31319VA002",,"VAN001","VAS001",,"New","POS","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$26.01",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Nationwide coverage from the Delta Dental system of networks","Yes",,,,,"31319VA0020005-00","Standard High Off Exchange Plan","85.00%",,,,"Yes","68%","32%","$700","$1,400","$700","$1,400","$700","$1,400","$700","$1,400",,,,,,,,,,,,,,,,,"$50","$100",,"$50","$100",,"$50","$100","$50","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","4","88380","VA","Individual","No","54-1356687","88380VA0720001","Anthem HealthKeepers Bronze DirectAccess - caam","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUL","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720001-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","4","88380","VA","Individual","No","54-1356687","88380VA0720001","Anthem HealthKeepers Bronze DirectAccess - caam","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","2","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUL","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720001-03","Limited Cost Sharing Plan Variation","60.00%","0.600980877876282","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","25%","$5,500","$11,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720002","Anthem HealthKeepers Bronze DirectAccess w/HSA - caas","88380VA072",,"VAN001","VAS001","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUN","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720002-01","Standard Bronze On Exchange Plan","58.18%","0.58153623342514","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","15%","$6,000","$12,000","15%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","1","38234","VA","Individual","No","06-6033492","38234VA0060002","Aetna Advantage 6350: MO","38234VA006",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060002-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","1","38234","VA","Individual","No","06-6033492","38234VA0060002","Aetna Advantage 6350: MO","38234VA006",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060002-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","1","38234","VA","Individual","No","06-6033492","38234VA0060002","Aetna Advantage 6350: MO","38234VA006",,"VAN001","VAS001","VAF002","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060002-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","2","38234","VA","Individual","No","06-6033492","38234VA0060001","Aetna Advantage 6350","38234VA006",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060001-01","Standard Bronze On Exchange Plan","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","2","38234","VA","Individual","No","06-6033492","38234VA0060001","Aetna Advantage 6350","38234VA006",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","2","38234","VA","Individual","No","06-6033492","38234VA0060001","Aetna Advantage 6350","38234VA006",,"VAN001","VAS001","VAF001","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060001-03","Limited Cost Sharing Plan Variation","60.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","5","38234","VA","Individual","No","06-6033492","38234VA0060005","Aetna AdvantagePlus 5500 PD","38234VA006",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060005-00","Standard Bronze Off Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","5","38234","VA","Individual","No","06-6033492","38234VA0060005","Aetna AdvantagePlus 5500 PD","38234VA006",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060005-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","5","38234","VA","Individual","No","06-6033492","38234VA0060005","Aetna AdvantagePlus 5500 PD","38234VA006",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060005-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","5","38234","VA","Individual","No","06-6033492","38234VA0060005","Aetna AdvantagePlus 5500 PD","38234VA006",,"VAN001","VAS001","VAF005","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060005-03","Limited Cost Sharing Plan Variation","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","6","38234","VA","Individual","No","06-6033492","38234VA0060006","Aetna AdvantagePlus 5500 PD: MO","38234VA006",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060006-00","Standard Bronze Off Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","6","38234","VA","Individual","No","06-6033492","38234VA0060006","Aetna AdvantagePlus 5500 PD: MO","38234VA006",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060006-01","Standard Bronze On Exchange Plan","58.30%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","10%",,,,"$11,000","$22,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","6","38234","VA","Individual","No","06-6033492","38234VA0060006","Aetna AdvantagePlus 5500 PD: MO","38234VA006",,"VAN001","VAS001","VAF006","New","PPO","Bronze","Yes","Both","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060006-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-03","Limited Cost Sharing Plan Variation","69.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$5,000","$10,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-04","73% AV Level Silver Plan","73.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$3,500","$7,000","30%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-05","87% AV Level Silver Plan","87.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$600","$1,200","10%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","10","38234","VA","Individual","No","06-6033492","38234VA0060016","Aetna Classic 5000: MO","38234VA006",,"VAN001","VAS001","VAF016","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060016-06","94% AV Level Silver Plan","93.60%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,250","$2,500",,,"$12,700","$25,400","Not Applicable","Not Applicable","$150","$300","0%",,,,"$10,000","$20,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","13","38234","VA","Individual","No","06-6033492","38234VA0060011","Aetna Premier 2000 PD","38234VA006",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060011-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","13","38234","VA","Individual","No","06-6033492","38234VA0060011","Aetna Premier 2000 PD","38234VA006",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060011-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","Not Applicable","Not Applicable","Not Applicable","Not Applicable","0%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","13","38234","VA","Individual","No","06-6033492","38234VA0060011","Aetna Premier 2000 PD","38234VA006",,"VAN001","VAS001","VAF011","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060011-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","14","38234","VA","Individual","No","06-6033492","38234VA0060012","Aetna Premier 2000 PD: MO","38234VA006",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060012-01","Standard Gold On Exchange Plan","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","14","38234","VA","Individual","No","06-6033492","38234VA0060012","Aetna Premier 2000 PD: MO","38234VA006",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","Not Applicable","Not Applicable","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","14","38234","VA","Individual","No","06-6033492","38234VA0060012","Aetna Premier 2000 PD: MO","38234VA006",,"VAN001","VAS001","VAF012","New","PPO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060012-03","Limited Cost Sharing Plan Variation","78.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$4,500","$9,000",,,"$9,000","$18,000","Not Applicable","Not Applicable","$2,000","$4,000","30%",,,,"$4,000","$8,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","50%",,,,"Not Applicable","Not Applicable","$500","$1,000",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","15","38234","VA","Individual","No","06-6033492","38234VA0060007","Aetna Basic","38234VA006",,"VAN001","VAS001","VAF007","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060007-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","38234","SERFF","5","2014-01-17 15:54:39","16","38234","VA","Individual","No","06-6033492","38234VA0060008","Aetna Basic: MO","38234VA006",,"VAN001","VAS001","VAF008","New","PPO","Catastrophic","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Heart Disease, Diabetes",,"0.997586380903032",,,"0","0","0","2014-01-01",,"No",,"Yes","Covered With Limitations.","No","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html",,"http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","http://www.aetna.com/individuals-families-health-insurance/buy-insurance/exchange/va.html","38234VA0060008-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$15,000","$30,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0260003","BluePreferred PPO HSA/HRA $4,000","40308VA026",,"VAN002","VAS001","VAF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996826577452055",,,"0","0","0","2014-01-01",,"Yes","All covered services","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BPHVB05ARXCVB05EN012014.pdf",,,"www.carefirst.com/acarx","40308VA0260003-01","Standard Bronze On Exchange Plan","60.85%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","30%",,,,"$8,000","$16,000","$12,000","$24,000","$4,000","$20","$990","$150","$4,000","$130","$120","$80","4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","Individual","Yes","53-0078070","40308VA0320001","BlueDental Preferred","40308VA032",,"VAN002","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0320001-01","Standard High On Exchange Plan","86.39%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$50","$150","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0330001","BlueDental Preferred","40308VA033",,"VAN002","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.50",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0330001-01","Standard High On Exchange Plan","86.39%",,,,"No","100%",,"$700","$1400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$50","$150","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","Individual","No","53-0078070","40308VA0240001","BluePreferred Platinum $0","40308VA024",,"VAN002","VAS001","VAF004","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996569042845628",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPPVBN8ARXXVBN81N012014.pdf",,,,"40308VA0240001-01","Standard Platinum On Exchange Plan","88.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$3,600","$7,200","$5,400","$10,800","$0","$0","10%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$520","$150","$0","$200","$710","$80","4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","Individual","Yes","53-0078070","40308VA0320003","BlueDental Preferred","40308VA032",,"VAN002","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.22",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0320003-00","Standard High Off Exchange Plan","86.39%",,,,"No","100%",,"$700","$1,400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$50","$150","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0330002","BlueDental Preferred","40308VA033",,"VAN002","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$7.50",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0330002-00","Standard High Off Exchange Plan","86.39%",,,,"No","100%",,"$700","$1400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$25","$75",,,,,"$50","$150","$75","$225",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","Individual","No","53-0078070","40308VA0240001","BluePreferred Platinum $0","40308VA024",,"VAN002","VAS001","VAF004","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996569042845628",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPPVBN8ARXXVBN81N012014.pdf",,,,"40308VA0240001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0340001","BlueDental Traditional","40308VA034",,"VAN002","VAS001",,"New","PPO","High",,"On the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0340001-01","Standard High On Exchange Plan","86.39%",,,,"No","100%",,"$700","$1400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","$100","$300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","Individual","No","53-0078070","40308VA0240001","BluePreferred Platinum $0","40308VA024",,"VAN002","VAS001","VAF004","New","PPO","Platinum","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996569042845628",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPPVBN8ARXXVBN81N012014.pdf",,,,"40308VA0240001-03","Limited Cost Sharing Plan Variation","88.20%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,800","$3,600",,,"$3,600","$7,200","$5,400","$10,800","$0","$0","10%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$0","$520","$150","$0","$200","$710","$80","6"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","1","40308","VA","SHOP (Small Group)","Yes","53-0078070","40308VA0340002","BlueDental Traditional","40308VA034",,"VAN002","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$8.24",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","All Covered Services","Yes","All Covered Services","Yes",,,,,"40308VA0340002-00","Standard High Off Exchange Plan","86.39%",,,,"No","100%",,"$700","$1400",,,"$0","$0","$700","$1,400",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","$100","$300",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","2","40308","VA","Individual","No","53-0078070","40308VA0250001","BluePreferred HSA Bronze $3,500","40308VA025",,"VAN002","VAS001","VAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996553085120379",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPHVBN5ARXCVBN5CN012014.pdf",,,,"40308VA0250001-01","Standard Bronze On Exchange Plan","61.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","$10,500","$21,000","$3,500","$0","$760","$150","$3,500","$30","$330","$80","4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","2","40308","VA","SHOP (Small Group)","No","53-0078070","40308VA0270007","BluePreferred PPO 100% / 80%","40308VA027",,"VAN002","VAS001","VAF003","New","PPO","Platinum","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996826577452055",,,"0","0","0","2014-01-01",,"Yes","All covered services","Yes","All covered services","Yes","http://content.carefirst.com/sbc/BPPVB08CRXXVB08JN012014.pdf",,,"www.carefirst.com/acarx","40308VA0270007-01","Standard Platinum On Exchange Plan","89.44%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$4,000","$8,000","$6,000","$12,000","$0","$0","0%",,,,"$1,000","$2,000","$1,000","$2,000","$0","$0","20%",,,,"$0","$0","$0","$0",,,,,,,,,,,"$0","$20","$0","$150","$0","$600","$0","$80","4"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","2","40308","VA","Individual","No","53-0078070","40308VA0250001","BluePreferred HSA Bronze $3,500","40308VA025",,"VAN002","VAS001","VAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996553085120379",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPHVBN5ARXCVBN5CN012014.pdf",,,,"40308VA0250001-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","5"
"2014","VA","40308","SERFF","10","2014-07-28 14:39:22","2","40308","VA","Individual","No","53-0078070","40308VA0250001","BluePreferred HSA Bronze $3,500","40308VA025",,"VAN002","VAS001","VAF004","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.996553085120379",,,"0","0","0","2014-01-01",,"Yes","Emergency Services only","Yes","Emergency Services only","Yes","http://content.carefirst.com/sbc/BPHVBN5ARXCVBN5CN012014.pdf",,,,"40308VA0250001-03","Limited Cost Sharing Plan Variation","61.20%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"$7,000","$14,000","$10,500","$21,000","$3,500","$0","$760","$150","$3,500","$30","$330","$80","6"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0200001","Guardian Pediatric Advantage","42808VA020",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0200001-00","Standard High Off Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0200001","Guardian Pediatric Advantage","42808VA020",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0200001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","1","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0210001","Guardian Pediatric Essentials","42808VA021",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0210001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720002","Anthem HealthKeepers Bronze DirectAccess w/HSA - caas","88380VA072",,"VAN001","VAS001","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUN","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720002","Anthem HealthKeepers Bronze DirectAccess w/HSA - caas","88380VA072",,"VAN001","VAS001","VAF002","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUN","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720002-03","Limited Cost Sharing Plan Variation","58.18%","0.58153623342514","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,000","$12,000","15%","$6,000","$12,000","15%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","4","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0230001","Guardian Family Advantage","42808VA023",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.36",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0230001-01","Standard High On Exchange Plan","85.30%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","4","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0250001","Guardian Family Essentials","42808VA025",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0250001-00","Standard Low Off Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","42808","SERFF","3","2013-11-27 09:24:34","4","42808","VA","SHOP (Small Group)","Yes","13-5123390","42808VA0250001","Guardian Family Essentials","42808VA025",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.63",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of the service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,,,"42808VA0250001-01","Standard Low On Exchange Plan","69.70%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500002","KP VA Platinum 500/20/Dental","95185VA050",,"VAN001","VAS001","VAF013","New","HMO","Platinum","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500002-01","Standard Platinum On Exchange Plan",,"0.889344573020935","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-05","87% AV Level Silver Plan",,"0.867990612983704","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","VA","44721","SERFF","1","2013-08-01 21:15:43","1","44721","VA","SHOP (Small Group)","Yes","35-0472300","44721VA0010001","DentalConnect�","44721VA001",,"VAN001","VAS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$32.29",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"44721VA0010001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","44721","SERFF","1","2013-08-01 21:15:43","1","44721","VA","SHOP (Small Group)","Yes","35-0472300","44721VA0010002","DentalConnect�","44721VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.00",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"44721VA0010002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","44721","SERFF","1","2013-08-01 21:15:43","2","44721","VA","SHOP (Small Group)","Yes","35-0472300","44721VA0010003","DentalConnect�","44721VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.25",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"44721VA0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","1","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0160001","EHB Basic Dental Plan (Low)","72006VA016",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48061",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48060",,"72006VA0160001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","1","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0160001","EHB Basic Dental Plan (Low)","72006VA016",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=48061",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=48060",,"72006VA0160001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$75","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","2","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0170001","EHB Enhanced Dental Plan (High)","72006VA017",,"VAN002","VAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$24.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49130",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49129",,"72006VA0170001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-01","Standard Silver On Exchange Plan","68.94%","0.688939809799194","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","20%","$2,600","$5,200","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-03","Limited Cost Sharing Plan Variation","68.94%","0.688939809799194","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,000","$12,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,600","$5,200","20%","$2,600","$5,200","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-04","73% AV Level Silver Plan","72.00%","0.722172379493713","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","20%","$2,500","$5,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-05","87% AV Level Silver Plan","86.11%","0.862264335155487","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"8"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720007","Anthem HealthKeepers Silver DirectAccess - cbfs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVB","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720007-06","94% AV Level Silver Plan","93.05%","0.931267976760864","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%","$200","$400","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500005","KP VA Gold 1000/30/Dental","95185VA050",,"VAN001","VAS001","VAF015","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500005-01","Standard Gold On Exchange Plan",,"0.795810580253601","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","90%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-06","94% AV Level Silver Plan",,"0.931547224521637","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-01","Standard Silver On Exchange Plan",,"0.685792088508606","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500008","KP VA Silver 1250/35/Dental","95185VA050",,"VAN001","VAS001","VAF017","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500008-01","Standard Silver On Exchange Plan",,"0.713347494602203","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500009","KP VA Silver 2000/35/Dental","95185VA050",,"VAN001","VAS001","VAF017","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500009-01","Standard Silver On Exchange Plan",,"0.719432234764099","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,000","$4,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","100%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"17"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500012","KP VA Bronze 4500/50/Dental","95185VA050",,"VAN001","VAS001","VAF018","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500012-01","Standard Bronze On Exchange Plan",,"0.611622273921967","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,"18"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-03","Limited Cost Sharing Plan Variation",,"0.685792088508606","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$2,500","$5,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-04","73% AV Level Silver Plan",,"0.731747090816498","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-05","87% AV Level Silver Plan",,"0.867990612983704","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-03","Limited Cost Sharing Plan Variation","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-04","73% AV Level Silver Plan","72.10%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-01","Standard Silver On Exchange Plan","69.30%","0.692541062831879","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0410031","Health Savings Blue PPO 1500","31274WV041",,"WVN001","WVS001","WVF008","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997779422532447",,,"0","0","0","2014-01-01",,"Yes","Blue Worldwide network participating providers","Yes","Blue Card PPO network participating providers","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0410031-01","Standard Gold On Exchange Plan","80.00%","0.781938672065735","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-05","87% AV Level Silver Plan",,"0.873120844364166","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-06","94% AV Level Silver Plan",,"0.940587222576141","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","5%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 4500/50/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF010","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530007-01","Standard Bronze On Exchange Plan",,"0.593177199363709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140019","Bronze $15 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.374305442678013",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73216","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140019-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140019","Bronze $15 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.374305442678013",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73216","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140019-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-03","Limited Cost Sharing Plan Variation",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340003","Health Savings Blue PPO 1300","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340003-01","Standard Gold On Exchange Plan",,"0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340003","Health Savings Blue PPO 1300","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340003-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340003","Health Savings Blue PPO 1300","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340003-03","Limited Cost Sharing Plan Variation",,"0.806593358516693","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,300","$4,600",,,"$4,600","$9,200","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","10%",,,,"$2,600","$5,200","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-01","Standard Silver On Exchange Plan","71.37%","0.71510124206543","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"11"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720010","Anthem HealthKeepers Gold DirectAccess - ccam","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWC","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720010-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720010","Anthem HealthKeepers Gold DirectAccess - ccam","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWC","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720010-03","Limited Cost Sharing Plan Variation","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-01","Standard Silver On Exchange Plan","69.49%","0.697258770465851","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%","$2,250","$4,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-03","Limited Cost Sharing Plan Variation","71.37%","0.71510124206543","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-04","73% AV Level Silver Plan","73.75%","0.73918491601944","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,250","$8,500","$4,250","$8,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","30%","$1,500","$3,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-05","87% AV Level Silver Plan","86.09%","0.861689567565918","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$725","$1,450","30%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"14"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","3","88380","VA","Individual","No","54-1356687","88380VA0720009","Anthem HealthKeepers Silver DirectAccess - cbky","88380VA072",,"VAN001","VAS001","VAF012","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVM","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720009-06","94% AV Level Silver Plan","93.02%","0.930883347988129","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$175","$350","30%","$200","$400","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720004","Anthem HealthKeepers Bronze DirectAccess w/HSA - cacd","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUS","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720004-01","Standard Bronze On Exchange Plan","61.60%","0.618120551109314","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","25%","$3,750","$7,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720004","Anthem HealthKeepers Bronze DirectAccess w/HSA - cacd","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUS","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720004-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","5","88380","VA","Individual","No","54-1356687","88380VA0720004","Anthem HealthKeepers Bronze DirectAccess w/HSA - cacd","88380VA072",,"VAN001","VAS001","VAF001","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RUS","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720004-03","Limited Cost Sharing Plan Variation","61.60%","0.618120551109314","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,200","$12,400","$6,200","$12,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,750","$7,500","25%","$3,750","$7,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720010","Anthem HealthKeepers Gold DirectAccess - ccam","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWC","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720010-01","Standard Gold On Exchange Plan","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-05","87% AV Level Silver Plan","86.07%","0.861834585666656","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$700","$1,400","20%","$700","$1,400","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-06","94% AV Level Silver Plan","93.09%","0.931601822376251","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","20%","$200","$400","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-01","Standard Silver On Exchange Plan","68.09%","0.68243670463562","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","15%","$3,350","$6,700","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"13"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"14"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-03","Limited Cost Sharing Plan Variation","68.09%","0.68243670463562","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$5,500","$11,000","$5,500","$11,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,350","$6,700","15%","$3,350","$6,700","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-04","73% AV Level Silver Plan","72.11%","0.722235023975372","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,500","$9,000","$4,500","$9,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,350","$4,700","15%","$2,350","$4,700","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-05","87% AV Level Silver Plan","86.14%","0.862133145332336","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$1,500","$3,000","$1,500","$3,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","15%","$750","$1,500","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"17"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720006","Anthem HealthKeepers Silver DirectAccess - cbau","88380VA072",,"VAN001","VAS001","VAF004","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV6","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720006-06","94% AV Level Silver Plan","93.01%","0.930681586265564","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$650","$1,300","$650","$1,300","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$200","$400","15%","$200","$400","45%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","7","88380","VA","Individual","No","54-1356687","88380VA0720012","Anthem HealthKeepers Catastrophic DirectAccess","88380VA072",,"VAN001","VAS001","VAF015","New","HMO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWL","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720012-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%","$6,350","$12,700","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","8","88380","VA","Individual","No","54-1356687","88380VA0720003","Anthem HealthKeepers Bronze DirectAccess - cabw","88380VA072",,"VAN001","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUQ","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720003-01","Standard Bronze On Exchange Plan","61.07%","0.611917436122894","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%","$4,500","$9,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","8","88380","VA","Individual","No","54-1356687","88380VA0720003","Anthem HealthKeepers Bronze DirectAccess - cabw","88380VA072",,"VAN001","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUQ","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720003-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","8","88380","VA","Individual","No","54-1356687","88380VA0720003","Anthem HealthKeepers Bronze DirectAccess - cabw","88380VA072",,"VAN001","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Must obtain pre-approval.","No","http://www.sbc.anthem.com/dps/CCD0RUQ","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720003-03","Limited Cost Sharing Plan Variation","61.07%","0.611917436122894","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%","$4,500","$9,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","27","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730001","Anthem HealthKeepers Gold Guided Access Plus-groa","88380VA073",,"VAN001","VAS001","VAF001","New","POS","Gold","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.987138753392335",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","http://file.anthem.com/37046VABENAHK.pdf","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/VASelectdrugtier3","88380VA0730001-01","Standard Gold On Exchange Plan","79.72%","0.803020298480988","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"$10,000","$20,000","$15,000","$30,000","$500","$1,500","20%",,,,"$1,000","$3,000","$1,500","$4,500","Not Applicable","Not Applicable","20%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","27","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730003","Anthem HealthKeepers Silver Guided Access Plus-gvoa","88380VA073",,"VAN001","VAS001","VAF001","New","POS","Silver","Yes","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.984397569808657",,,"0","0","3","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","http://file.anthem.com/37046VABENAHK.pdf","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/VASelectdrugtier3","88380VA0730003-01","Standard Silver On Exchange Plan","71.31%","0.715245723724365","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000","$2,000","$4,000","30%",,,,"$4,000","$8,000","$6,000","$12,000","Not Applicable","Not Applicable","30%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500004","KP VA Gold 0/30/Dental","95185VA050",,"VAN001","VAS001","VAF014","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"3","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500004-01","Standard Gold On Exchange Plan",,"0.813384234905243","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","100%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530002-01","Standard Gold On Exchange Plan",,"0.781146109104156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530002","KP VA Gold 1000/20/Dental","95185VA053",,"VAN001","VAS001","VAF002","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530002-03","Limited Cost Sharing Plan Variation",,"0.781146109104156","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-01","Standard Silver On Exchange Plan",,"0.701608300209045","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-03","Limited Cost Sharing Plan Variation",,"0.701608300209045","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530003","KP VA Silver 1500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530003-04","73% AV Level Silver Plan",,"0.731747090816498","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$250","$500","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040001","Select Plan Kids","54965VA004",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","Individual","Yes","54-1808292","54965VA0020001","Select Plan Kids","54965VA002",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","Individual","Yes","54-1808292","54965VA0020001","Select Plan Kids","54965VA002",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobiped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040001","Select Plan Kids","54965VA004",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0040001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","Individual","Yes","54-1808292","54965VA0030001","Access PPO Kids","54965VA003",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0030001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050001","Access PPO Kids","54965VA005",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0050001-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","Individual","Yes","54-1808292","54965VA0030001","Access PPO Kids","54965VA003",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcoviped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0030001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","1","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050001","Access PPO Kids","54965VA005",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopped-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0050001-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","Individual","Yes","54-1808292","54965VA0020002","Select Plan","54965VA002",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","1","88380","VA","Individual","No","54-1356687","88380VA0720005","Anthem HealthKeepers Bronze DirectAccess w/Child Dental - cdbw","88380VA072",,"VAN002","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV2","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720005-03","Limited Cost Sharing Plan Variation","61.07%","0.611917436122894","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%","$4,500","$9,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","2","88380","VA","Individual","No","54-1356687","88380VA0720011","Anthem HealthKeepers Gold DirectAccess w/Child Dental - cdda","88380VA072",,"VAN002","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720011-01","Standard Gold On Exchange Plan","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","2","88380","VA","Individual","No","54-1356687","88380VA0720011","Anthem HealthKeepers Gold DirectAccess w/Child Dental - cdda","88380VA072",,"VAN002","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720011-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","2","88380","VA","Individual","No","54-1356687","88380VA0720011","Anthem HealthKeepers Gold DirectAccess w/Child Dental - cdda","88380VA072",,"VAN002","VAS001","VAF007","New","HMO","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RWG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720011-03","Limited Cost Sharing Plan Variation","79.39%","0.794877767562866","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$3,500","$7,000","$3,500","$7,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$750","$1,500","20%","$750","$1,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040002","Select Plan","54965VA004",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","Individual","Yes","54-1808292","54965VA0020002","Select Plan","54965VA002",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0040002","Select Plan","54965VA004",,"VAN001","VAS001",,"New","HMO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","Yes","Emergency pain treatment only if 50 miles away from home ZIP code, up to $100","No","https://www.dominiondental.com/files/plan/FEDVIP/va14dobshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0040002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050002","Access PPO","54965VA005",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0050002-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","Individual","Yes","54-1808292","54965VA0030002","Access PPO","54965VA003",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0030002-00","Standard Low Off Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","SHOP (Small Group)","Yes","54-1808292","54965VA0050002","Access PPO","54965VA005",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovshopfam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0050002-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","54965","SERFF","4","2013-09-05 10:37:54","2","54965","VA","Individual","Yes","54-1808292","54965VA0030002","Access PPO","54965VA003",,"VAN002","VAS002",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$22.62",,"Estimated Rate",,"0","0","0","2014-01-01",,"Yes","Standard PPO coverage","Yes","Standard PPO coverage","Yes","https://www.dominiondental.com/files/plan/FEDVIP/va14pcovifam-hix.pdf",,"https://www.dominiondental.com/health-care-reform-individuals-and-families-virginia",,"54965VA0030002-01","Standard Low On Exchange Plan","71.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$100","$100",,,,,"$100","$100","$100","$100",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","2","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0170001","EHB Enhanced Dental Plan (High)","72006VA017",,"VAN002","VAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Child-Only",,,,"$24.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49130",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49129",,"72006VA0170001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","3","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0180001","Family Basic Dental Plan (Low)*","72006VA018",,"VAN003","VAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49132",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49131",,"72006VA0180001-00","Standard Low Off Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","3","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0180001","Family Basic Dental Plan (Low)*","72006VA018",,"VAN003","VAS001",,"New","PPO","Low",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$19.62",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49132",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49131",,"72006VA0180001-01","Standard Low On Exchange Plan","70.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","4","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0190001","Family Enhanced Dental Plan (High)","72006VA019",,"VAN004","VAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$24.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49134",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49133",,"72006VA0190001-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","72006","SERFF","7","2013-11-27 09:24:34","4","72006","VA","SHOP (Small Group)","Yes","13-5581829","72006VA0190001","Family Enhanced Dental Plan (High)","72006VA019",,"VAN004","VAS001",,"New","PPO","High",,"Both",,,,"When sold off the exchange, MetLife's Dental EHB plans and benefits will meet the stated actuarial value, but the exact plan and benefit design may vary according to the terms of the insurance certificate.",,,,,"Allows Adult and Child-Only",,,,"$24.58",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Payment is made to the employee in U.S. dollars and is based upon the rate of exchange for the date in which the expense was incurred. Covered services should be a recognized ADA procedure code to identify the service provided.","Yes","The PPO plan has an indemnity schedule of benefits for out of service area coverage.","Yes","https://eforms.metlife.com/wcm8/OIDAction.do?OID=49134",,"https://eforms.metlife.com/wcm8/OIDAction.do?OID=49133",,"72006VA0190001-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"$50","$150","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","1","88380","VA","Individual","No","54-1356687","88380VA0720005","Anthem HealthKeepers Bronze DirectAccess w/Child Dental - cdbw","88380VA072",,"VAN002","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV2","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720005-01","Standard Bronze On Exchange Plan","61.07%","0.611917436122894","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","35%","$4,500","$9,000","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","1","88380","VA","Individual","No","54-1356687","88380VA0720005","Anthem HealthKeepers Bronze DirectAccess w/Child Dental - cdbw","88380VA072",,"VAN002","VAS001","VAF003","New","HMO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","3","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RV2","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720005-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-03","Limited Cost Sharing Plan Variation","69.49%","0.697258770465851","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,250","$4,500","20%","$2,250","$4,500","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","6","88380","VA","Individual","No","54-1356687","88380VA0720008","Anthem HealthKeepers Silver DirectAccess - cbjs","88380VA072",,"VAN001","VAS001","VAF007","New","HMO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"No","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"1",,,"0","0","0","2014-01-01",,"Yes","Must obtain pre-approval.","Yes","Emergency and Urgent Care only.","No","http://www.sbc.anthem.com/dps/CCD0RVG","https://shop.anthem.com/sales/eox/payment/landing/va","http://file.anthem.com/03268VAMENAHK.pdf","www.anthem.com/VASelectdrugtier4","88380VA0720008-04","73% AV Level Silver Plan","72.29%","0.725026190280914","Yes","Yes","Yes","70%","30%",,,,,,,,,,,,,,,,,"$4,700","$9,400","$4,700","$9,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,050","$4,100","20%","$2,050","$4,100","50%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","88380","SERFF","7","2014-03-17 13:54:37","28","88380","VA","SHOP (Small Group)","No","54-1356687","88380VA0730005","Anthem HealthKeepers Bronze Guided Access Plus w/HSA-gjdb","88380VA073",,"VAN001","VAS001","VAF002","New","POS","Bronze","No","On the Exchange","No","Yes","All but Primary Care Physicians, OBGYNs and Emergency Care",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy",,"0.979381194714836",,,"0","0","0","2014-01-01",,"Yes","Follows OON Coverage","Yes","Follows OON Coverage","No","http://sbc.anthem.com","http://file.anthem.com/37046VABENAHK.pdf","http://file.anthem.com/03395ANMENABS.pdf","www.anthem.com/VASelectdrugtier4","88380VA0730005-01","Standard Bronze On Exchange Plan",,"0.610353112220764","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,500","$11,000",,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","0%",,,,"$11,000","$22,000","$16,500","$33,000",,,,,,,,,"4"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530001-01","Standard Gold On Exchange Plan",,"0.811570644378662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-03","Limited Cost Sharing Plan Variation",,"0.689185261726379","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-04","73% AV Level Silver Plan",,"0.732318162918091","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,300","$2,600","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0010001","DentaQuest Dental Plan Pediatric High","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$45.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020001","DentaQuest Dental Plan Pediatric High","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020001-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0010002","DentaQuest Dental Plan Pediatric Low","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020002","DentaQuest Dental Plan Pediatric Low","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020002-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020002","DentaQuest Dental Plan Pediatric Low","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$23.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0010002","DentaQuest Dental Plan Pediatric Low","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010002-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030001","Choice Pediatric Option 1","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$54.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040001","Choice Pediatric Option 1","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040001-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030001","Choice Pediatric Option 1","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$54.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030004","Choice Family Option 2","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$70.90",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030004-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140001","Gold $5 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140001-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140001","Gold $5 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140001-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140001","Gold $5 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73207","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140001-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140006","Gold $0 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73223","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140006-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420021","Shared Cost Blue PPO 1750","31274WV042",,"WVN001","WVS001","WVF006","New","PPO","Silver","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997779422532447",,,"0","0","0","2014-01-01",,"Yes","Blue Worldwide network participating providers","Yes","Blue Card PPO network participating providers","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0420021-01","Standard Silver On Exchange Plan","70.00%","0.712581753730774","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,750","$3,500","30%",,,,"$3,500","$7,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","5","99663","VA","Individual","No","54-1576305","99663VA0140003","Bronze $10 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73203","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140003-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","5","99663","VA","Individual","No","54-1576305","99663VA0140003","Bronze $10 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73203","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140003-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","6","99663","VA","Individual","No","54-1576305","99663VA0140014","Bronze $10 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500946423981672",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140014-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","6","99663","VA","Individual","No","54-1576305","99663VA0140014","Bronze $10 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500946423981672",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140014-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140011","Bronze $15 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73233","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140011-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140011","Bronze $15 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73233","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140011-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-03","Limited Cost Sharing Plan Variation",,"0.699418485164642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340001-03","Limited Cost Sharing Plan Variation",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-01","Standard Silver On Exchange Plan","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-04","73% AV Level Silver Plan",,"0.722863674163818","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800","$4,000","$8,000","20%",,,,"$9,500","$19,000","$13,500","$27,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-02","Zero Cost Sharing Plan Variation","100.00%","1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","1","95185","VA","Individual","No","52-0954463","95185VA0530001","KP VA Gold 0/20/Dental","95185VA053",,"VAN001","VAS001","VAF001","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530001-03","Limited Cost Sharing Plan Variation",,"0.811570644378662","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","1","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500001","KP VA Platinum 0/20/Dental","95185VA050",,"VAN001","VAS001","VAF012","New","HMO","Platinum","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500001-01","Standard Platinum On Exchange Plan",,"0.902550458908081","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","Not Applicable","100%",,,,"Not Applicable","Not Applicable","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030002","Choice Pediatric Option 2","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$70.90",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030002-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040002","Choice Pediatric Option 2","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040002-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040002","Choice Pediatric Option 2","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$47.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040002-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-03","Limited Cost Sharing Plan Variation","70.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-04","73% AV Level Silver Plan","73.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-01","Standard Silver On Exchange Plan","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-03","Limited Cost Sharing Plan Variation","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-04","73% AV Level Silver Plan","72.10%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040004","Choice Family Option 2","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040004-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040004","Choice Family Option 2","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$47.95",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040004-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140006","Gold $0 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73223","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140006-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0030002","Choice Pediatric Option 2","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$70.90",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030002-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"11"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020003","DentaQuest Dental Plan Family High","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0010003","DentaQuest Dental Plan Family High","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010003-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","2","95185","VA","Individual","No","52-0954463","95185VA0530004","KP VA Silver 2500/30/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530004-06","94% AV Level Silver Plan",,"0.931547224521637","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530005","KP VA Silver 1750/25%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF003","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530005-01","Standard Silver On Exchange Plan",,"0.689185261726379","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$1,750","$3,500","25%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 4500/50/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF010","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530007-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"14"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530007","KP VA Bronze 4500/50/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF010","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"4","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530007-03","Limited Cost Sharing Plan Variation",,"0.593177199363709","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"15"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 5000/30%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF011","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530008-01","Standard Bronze On Exchange Plan",,"0.588992476463318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"16"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 5000/30%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF011","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530008-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"17"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","Individual","No","52-0954463","95185VA0530008","KP VA Bronze 5000/30%/HSA/Dental","95185VA053",,"VAN001","VAS001","VAF011","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530008-03","Limited Cost Sharing Plan Variation",,"0.588992476463318","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","30%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"18"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500003","KP VA Platinum 1250/10/HSA/HRA/Dental","95185VA050",,"VAN001","VAS001","VAF020","New","HMO","Platinum","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","Yes","$625.00","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500003-01","Standard Platinum On Exchange Plan",,"0.887722015380859","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","0%",,,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,"18"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500006","KP VA Gold 1250/0%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF016","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500006-01","Standard Gold On Exchange Plan",,"0.803396582603455","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,500","$5,000",,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,,,,,,,,,,,,,"$1,250","$2,500","100%",,,,"Not Applicable","Not Applicable","$1,250","$2,500",,,,,,,,,"19"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500007","KP VA Gold 1500/30/HSA/HRA/Dental","95185VA050",,"VAN001","VAS001","VAF017","New","HMO","Gold","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","Yes","$750.00","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500007-01","Standard Gold On Exchange Plan",,"0.811041116714478","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","90%",,,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,"20"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500010","KP VA Silver 1500/30/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF017","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500010-01","Standard Silver On Exchange Plan",,"0.705298185348511","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","$5,000","$10,000",,,,,,,,,,,,,,,,,,,,,"$1,500","$3,000","80%",,,,"Not Applicable","Not Applicable","$1,500","$3,000",,,,,,,,,"21"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500011","KP VA Silver 2500/30/HSA/HRA/Dental","95185VA050",,"VAN001","VAS001","VAF017","New","HMO","Silver","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","Yes","$500.00","Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500011-01","Standard Silver On Exchange Plan",,"0.719380855560303","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","70%",,,,"Not Applicable","Not Applicable","$2,500","$5,000",,,,,,,,,"22"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500013","KP VA Bronze 3500/20%/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF018","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500013-01","Standard Bronze On Exchange Plan",,"0.609161138534546","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$3,500","$7,000","20%",,,,"Not Applicable","Not Applicable","$3,500","$7,000",,,,,,,,,"23"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","3","95185","VA","SHOP (Small Group)","No","52-0954463","95185VA0500014","KP VA Bronze 4500/20/HSA/Dental","95185VA050",,"VAN001","VAS001","VAF018","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.985087787800065",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/smallbusiness/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","https://businessnet.kaiserpermanente.org/health/plans","www.kp.org/formulary","95185VA0500014-01","Standard Bronze On Exchange Plan",,"0.611759126186371","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","$6,350","$12,700",,,,,,,,,,,,,,,,,,,,,"$4,500","$9,000","100%",,,,"Not Applicable","Not Applicable","$4,500","$9,000",,,,,,,,,"24"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","4","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530006-01","Standard Bronze On Exchange Plan",,"0.600537419319153","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","4","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530006-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","4","95185","VA","Individual","No","52-0954463","95185VA0530006","KP VA Bronze 4500/50/Dental","95185VA053",,"VAN001","VAS001","VAF008","New","HMO","Bronze","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","0","0","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530006-03","Limited Cost Sharing Plan Variation",,"0.600537419319153","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$4,500","$9,000","20%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$500","$1,000","50%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","95185","SERFF","8","2014-01-17 15:54:39","5","95185","VA","Individual","No","52-0954463","95185VA0530009","KP VA Catastrophic 6350/0/Dental","95185VA053",,"VAN001","VAS001","VAF009","New","HMO","Catastrophic","No","On the Exchange","Yes","Yes","Referrals are required for all Plan specialists with the exception of OB/GYN, Mental Health, Alcohol/Chemical Dependency, Chiropractic Medicine",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes, Pain Management",,"0.987909415927778",,,"0","3","3","2014-01-01",,"Yes","Emergency Care Only","Yes","Emergency Care Only","No","http://info.kp.org/healthplans/virginia/individual/summary-benefits-coverage"," https://www.billerpayments.com/saml/hix/kpvibp","http://individual-family.kaiserpermanente.org/healthinsurance/health-plan-coverage-and-costs","www.kp.org/formulary","95185VA0530009-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","Individual","Yes","75-1233841","97762VA0010001","Dentegra Dental PPO Children's Plan 70","97762VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010001",,"97762VA0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.71",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020001",,"97762VA0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","Individual","Yes","75-1233841","97762VA0010001","Dentegra Dental PPO Children's Plan 70","97762VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010001",,"97762VA0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$25.71",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020001",,"97762VA0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","Individual","Yes","75-1233841","97762VA0010002","Dentegra Dental PPO Children's Plan 85","97762VA001",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010002",,"97762VA0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020002","Dentegra Dental PPO Children's Plan 85","97762VA002",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020002",,"97762VA0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020002","Dentegra Dental PPO Children's Plan 85","97762VA002",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020002",,"97762VA0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","1","97762","VA","Individual","Yes","75-1233841","97762VA0010002","Dentegra Dental PPO Children's Plan 85","97762VA001",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$31.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010002",,"97762VA0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","2","97762","VA","Individual","Yes","75-1233841","97762VA0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","97762VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010006",,"97762VA0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","2","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.71",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020006",,"97762VA0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","2","97762","VA","Individual","Yes","75-1233841","97762VA0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","97762VA001",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.51",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010006",,"97762VA0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","2","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$25.71",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020006",,"97762VA0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$40","Not Applicable",,,,,"$40","Not Applicable","$40","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","3","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020004",,"97762VA0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","3","97762","VA","Individual","Yes","75-1233841","97762VA0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","97762VA001",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010004",,"97762VA0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","3","97762","VA","Individual","Yes","75-1233841","97762VA0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","97762VA001",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.28",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/va/97762va0010004",,"97762VA0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97762","SERFF","4","2014-01-22 11:51:12","3","97762","VA","SHOP (Small Group)","Yes","75-1233841","97762VA0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","97762VA002",,"VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$31.53",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","National Coverage","Yes",,,"dentegra.com/hx/va/97762va0020004",,"97762VA0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","$25","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","Individual","Yes","52-2016912","97927VA0010001","DentaQuest Dental Plan Pediatric High","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$45.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020001","DentaQuest Dental Plan Pediatric High","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$29.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020001-00","Standard High Off Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","1","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040001","Choice Pediatric Option 1","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$36.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040001-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0010003","DentaQuest Dental Plan Family High","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$45.53",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020003","DentaQuest Dental Plan Family High","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$29.03",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020003-01","Standard High On Exchange Plan","84.80%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","$150",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0010004","DentaQuest Dental Plan Family Low","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020004","DentaQuest Dental Plan Family Low","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020004-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0010004","DentaQuest Dental Plan Family Low","97927VA001","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.52",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0010004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0020004","DentaQuest Dental Plan Family Low","97927VA002","7700889935","VAN001","VAS001",,"New","EPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.28",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Emergency Only. In excess of 50 miles from nearest provider.","No","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0020004-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","$225",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030003","Choice Family Option 1","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$54.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030003-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040003","Choice Family Option 1","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040003-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"8"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030003","Choice Family Option 1","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$54.64",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030003-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","SHOP (Small Group)","Yes","52-2016912","97927VA0040003","Choice Family Option 1","97927VA004","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$36.41",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.dentaquest.com/marketplace/va/","https://paydirect.dentaquest.com","http://www.dentaquest.com/marketplace/va/",,"97927VA0040003-01","Standard High On Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"9"
"2014","VA","97927","SERFF","3","2013-11-27 09:24:34","2","97927","VA","Individual","Yes","52-2016912","97927VA0030004","Choice Family Option 2","97927VA003","7700889935","VAN001","VAS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$70.90",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"Yes","Will process only translated claims.","Yes","Emergency Only. In excess of 50 miles from nearest provider.","Yes","http://www.Dentaquest.com/marketplace/va","https://paydirect.dentaquest.com","http://www.Dentaquest.com/marketplace/va",,"97927VA0030004-00","Standard High Off Exchange Plan","84.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","$150",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140006","Gold $0 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73223","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140006-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140009","Gold $0 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73239","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140009-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140009","Gold $0 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73239","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140009-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","1","99663","VA","Individual","No","54-1576305","99663VA0140009","Gold $0 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73239","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140009-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140004","Bronze Deductible Only POS Plan","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140004-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140023","Bronze Deductible Only HMO Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140023-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140023","Bronze Deductible Only HMO Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140023-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140023","Bronze Deductible Only HMO Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73219","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140023-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-01","Standard Gold On Exchange Plan",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-05","87% AV Level Silver Plan","87.50%","0.874960958957672","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,000","$4,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$500","$1,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"11"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310001","Blue Cross Blue Shield Shared Cost 1500, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310001-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-06","94% AV Level Silver Plan","94.10%","0.941233038902283","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$750","$1,500",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$100","$200","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330004-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"14"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330004-03","Limited Cost Sharing Plan Variation",,"0.79634553194046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"15"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330005-01","Standard Gold On Exchange Plan",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"16"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330005-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140012","Gold $5 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.540556573311017",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140012-01","Standard Gold On Exchange Plan","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-03","Limited Cost Sharing Plan Variation","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"18"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-01","Standard Silver On Exchange Plan","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140010","Silver $10 Copay Carelink-Southside POS","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73241","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140010-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0410011","Health Savings Blue PPO 4000","31274WV041",,"WVN001","WVS001","WVF007","New","PPO","Bronze","Yes","On the Exchange","No","No",,,,"Yes","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997779422532447",,,"0","0","0","2014-01-01",,"Yes","Blue Worldwide network participating providers","Yes","Blue Card PPO network participating providers","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0410011-01","Standard Bronze On Exchange Plan","60.00%","0.615120470523834","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$4,000","$8,000","20%",,,,"$8,000","$16,000","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140019","Bronze $15 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.374305442678013",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73216","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140019-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140022","Bronze $15 Copay POS Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.509334727437518",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73232","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140022-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140022","Bronze $15 Copay POS Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.509334727437518",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73232","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140022-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","12","99663","VA","Individual","No","54-1576305","99663VA0140022","Bronze $15 Copay POS Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.509334727437518",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73232","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140022-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-04","73% AV Level Silver Plan","72.10%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"19"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"20"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"21"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","5","99663","VA","Individual","No","54-1576305","99663VA0140003","Bronze $10 Copay POS Plan","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73203","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140003-01","Standard Bronze On Exchange Plan","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-01","Standard Silver On Exchange Plan",,"0.699418485164642","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340001","Health Savings Blue PPO 3000","31274WV034",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340001-01","Standard Bronze On Exchange Plan",,"0.617272973060608","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$3,000","$6,000","40%",,,,"$6,000","$12,000","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","6","99663","VA","Individual","No","54-1576305","99663VA0140014","Bronze $10 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF002","New","POS","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500946423981672",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73202","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140014-03","Limited Cost Sharing Plan Variation","61.90%",,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,600","$11,200","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140004","Bronze Deductible Only POS Plan","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140004-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140004","Bronze Deductible Only POS Plan","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73201","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140004-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140012","Gold $5 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.540556573311017",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140012-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140025","Bronze Deductible Only HMO Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140025-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140025","Bronze Deductible Only HMO Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140025-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140015","Bronze Deductible Only POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500295984427492",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73200","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140015-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140015","Bronze Deductible Only POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500295984427492",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73200","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140015-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140015","Bronze Deductible Only POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Bronze","No","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.500295984427492",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73200","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140015-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140027","Bronze Deductible Only HMO Carelink-Bon Secours- MOC","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.373343221064921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73218","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140027-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140027","Bronze Deductible Only HMO Carelink-Bon Secours- MOC","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.373343221064921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73218","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140027-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140027","Bronze Deductible Only HMO Carelink-Bon Secours- MOC","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.373343221064921",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73218","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140027-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140029","Bronze Deductible Only HMO Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.508813666511114",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140029-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140029","Bronze Deductible Only HMO Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.508813666511114",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140029-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140012","Gold $5 Copay POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF001","New","POS","Gold","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.540556573311017",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73206","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140012-03","Limited Cost Sharing Plan Variation","78.30%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,000","$10,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","20%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$250","$500","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140017","Gold $0 Copay POS Carelink-Bon Secours -MOC","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.42481243568341",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73222","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140017-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140017","Gold $0 Copay POS Carelink-Bon Secours -MOC","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.42481243568341",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73222","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140017-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140017","Gold $0 Copay POS Carelink-Bon Secours -MOC","99663VA014",,"VAN001","VAS001","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.42481243568341",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73222","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140017-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140020","Gold $0 Copay POS Carelink-Southside -MOC","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548265243769184",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73238","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140020-01","Standard Gold On Exchange Plan","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140020","Gold $0 Copay POS Carelink-Southside -MOC","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548265243769184",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73238","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140020-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","2","99663","VA","Individual","No","54-1576305","99663VA0140020","Gold $0 Copay POS Carelink-Southside -MOC","99663VA014",,"VAN002","VAS002","VAF005","New","POS","Gold","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548265243769184",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73238","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140020-03","Limited Cost Sharing Plan Variation","78.00%",,"No","Yes","Yes","80%","20%",,,,,,,,,,,,,,,,,"$5,000","$10,000","$6,000","$12,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,250","$2,500","20%","$3,900","$7,800","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-01","Standard Silver On Exchange Plan","70.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-03","Limited Cost Sharing Plan Variation","70.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-04","73% AV Level Silver Plan","73.70%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-05","87% AV Level Silver Plan","86.50%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$2,250","$4,500",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$1,750","$3,500","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140002","Silver $10 Copay POS","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73209","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140002-06","94% AV Level Silver Plan","93.10%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%",,,,"$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-01","Standard Silver On Exchange Plan","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-03","Limited Cost Sharing Plan Variation","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-04","73% AV Level Silver Plan","72.10%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$5,200","$10,400","$5,200","$10,400","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$5,000","$10,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"13"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","3","99663","VA","Individual","No","54-1576305","99663VA0140007","Silver $10 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73225","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140007-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-01","Standard Silver On Exchange Plan","70.40%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","40%",,,,"$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140013","Silver $10 Copay POS-MOC","99663VA014",,"VAN003","VAS003","VAF004","New","POS","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.548143757725171",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73208","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140013-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-05","87% AV Level Silver Plan","86.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$2,250","$4,500","$2,250","$4,500","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","30%","$1,500","$3,000","40%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"14"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140018","Silver $10 Copay POS Carelink-Bon Secours-MOC","99663VA014",,"VAN001","VAS001","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.433980517365038",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73224","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140018-06","94% AV Level Silver Plan","93.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$1,000","$2,000","$2,000","$4,000","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$0","$0","10%","$0","$0","20%","$6,400","$12,800","Not Applicable","Not Applicable","$0","$0","0%","$0","$0","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"15"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-01","Standard Silver On Exchange Plan","68.80%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable","$3,750","$7,500","30%","$6,000","$12,000","40%","$6,400","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","0%","$1,000","$2,000","0%","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"16"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","4","99663","VA","Individual","No","54-1576305","99663VA0140021","Silver $10 Copay POS Carelink- Southside MOC","99663VA014",,"VAN002","VAS002","VAF004","New","POS","Silver","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.555681160842636",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73240","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140021-02","Zero Cost Sharing Plan Variation","100.00%",,"No","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0","$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"17"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","7","99663","VA","Individual","No","54-1576305","99663VA0140025","Bronze Deductible Only HMO Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73235","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140025-01","Standard Bronze On Exchange Plan",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","8","99663","VA","Individual","No","54-1576305","99663VA0140029","Bronze Deductible Only HMO Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Bronze","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.508813666511114",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73234","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140029-03","Limited Cost Sharing Plan Variation",,"0.581636846065521","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,300","$12,600",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,300","$12,600","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"12"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","9","99663","VA","Individual","No","54-1576305","99663VA0140005","Catastrophic 100% POS Plan","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73205","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140005-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","9","99663","VA","Individual","No","54-1576305","99663VA0140024","Catastrophic 100% HMO Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73221","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140024-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","9","99663","VA","Individual","No","54-1576305","99663VA0140026","Catastrophic 100% HMO Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73237","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140026-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","10","99663","VA","Individual","No","54-1576305","99663VA0140016","Catastrophic 100% POS Plan-MOC","99663VA014",,"VAN003","VAS003","VAF003","New","POS","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.300893429679149",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73204","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posva","www.c1formularyhix.com","99663VA0140016-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","10","99663","VA","Individual","No","54-1576305","99663VA0140028","Catastrophic 100% HMO Carelink-Bon Secours- MOC","99663VA014",,"VAN001","VAS001","VAF003","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.121102703090488",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73220","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmobonsecoursva","www.c1formularyhix.com","99663VA0140028-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","10","99663","VA","Individual","No","54-1576305","99663VA0140030","Catastrophic 100% HMO Carelink-Southside- MOC","99663VA014",,"VAN002","VAS002","VAF003","New","HMO","Catastrophic","No","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"0.312932509584554",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Services covered at out of network benefit","Yes","Medically Necessary Services covered at out of network benefit","No","http://www.coventryhealthcare.com/VA73236","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/hmosouthsideva","www.c1formularyhix.com","99663VA0140030-01","Standard Catastrophic On Exchange Plan",,,"Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$6,350","$12,700","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140008","Bronze $15 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73217","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140008-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"4"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140008","Bronze $15 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73217","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140008-02","Zero Cost Sharing Plan Variation","100.00%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$0","$0","$0","$0","$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%","$0","$0","0%","$0","$0","$0","$0",,,,,,,,,"5"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140008","Bronze $15 Copay POS Carelink-Bon Secours","99663VA014",,"VAN001","VAS001","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73217","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/posbonsecoursva","www.c1formularyhix.com","99663VA0140008-03","Limited Cost Sharing Plan Variation","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"6"
"2014","VA","99663","SERFF","5","2013-11-27 09:24:34","11","99663","VA","Individual","No","54-1576305","99663VA0140011","Bronze $15 Copay POS Carelink-Southside","99663VA014",,"VAN002","VAS002","VAF002","New","POS","Bronze","Yes","On the Exchange","No","Yes","All except OB-GYN and mental health providers",,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Diabetes",,"1",,,"0","0","0","2014-01-01","2014-12-31","Yes","Medically Necessary Covered Services","Yes","Medically Necessary Covered Services","No","http://www.coventryhealthcare.com/VA73233","https://ssoprod.healthplan.com/sp/ACS.saml2","www.coventryone.com/possouthsideva","www.c1formularyhix.com","99663VA0140011-01","Standard Bronze On Exchange Plan","61.50%",,"Yes","Yes","Yes","75%","25%",,,,,,,,,,,,,,,,,"$6,350","$12,700","$6,350","$12,700","Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$5,500","$11,000","40%","$6,000","$12,000","50%","$6,400","$12,800","Not Applicable","Not Applicable",,,,,,,,,"7"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","1","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0010001","Smile for Health Child C60A70","34848WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a70-ppo.pdf",,,,"34848WV0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","1","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0010001","Smile for Health Child C60A70","34848WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a70-ppo.pdf",,,,"34848WV0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","2","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0090001","Smile for Health Child C60","34848WV009",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in In-Service area","Yes",,,,,"34848WV0090001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-05","87% AV Level Silver Plan",,"0.87159663438797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","$14,200","$28,400","$500","$1,000","10%",,,,"$9,500","$19,000","$10,000","$20,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-03","Limited Cost Sharing Plan Variation","71.60%","0.716210186481476","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,500","$5,000","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0310002","Blue Cross Blue Shield Shared Cost 4750, a Multi-State Plan","31274WV031",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,,"0","0","0","2014-01-01","2014-12-31","Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","www.discoverhighmark.com","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0310002-06","94% AV Level Silver Plan",,"0.938876569271088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","$13,200","$26,400","$100","$200","10%",,,,"$9,500","$19,000","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","1","31274","WV","Individual","No","55-0624615","31274WV0340002","Health Savings Blue PPO 2500","31274WV034",,"WVN001","WVS001","WVF005","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","Yes",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","Same as network","Yes","Same as network","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0340002-04","73% AV Level Silver Plan","73.60%","0.736075758934021","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,"$2,100","$4,300","10%",,,,"$5,000","$10,000","Not Applicable","Not Applicable",,,,,,,,,"10"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-03","Limited Cost Sharing Plan Variation","69.30%","0.692541062831879","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-04","73% AV Level Silver Plan","73.90%","0.735553801059723","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$1,500","$3,000","20%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"7"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-05","87% AV Level Silver Plan","86.70%","0.878804564476013","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,000","$2,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$500","$1,000","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"8"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","2","31274","WV","Individual","No","55-0624615","31274WV0350002","Comprehensive Care Blue PPO 1500","31274WV035",,"WVN001","WVS001","WVF004","New","PPO","Silver","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9963",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350002-06","94% AV Level Silver Plan","94.20%","0.940599381923676","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","Not Applicable","Not Applicable","$100","$200","10%",,,,"$3,000","$6,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","3","31274","WV","SHOP (Small Group)","No","55-0624615","31274WV0420031","Shared Cost Blue PPO 1000","31274WV042",,"WVN001","WVS001","WVF001","New","PPO","Gold","Yes","On the Exchange","No","No",,,,"No","No",,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.997779422532447",,,"0","0","0","2014-01-01",,"Yes","Blue Worldwide network participating providers","Yes","Blue Card PPO network participating providers","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/cmcrst/x-services/hcr/v1/shop/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0420031-01","Standard Gold On Exchange Plan","80.00%","0.818437993526459","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,000","$6,000",,,"$6,000","$12,000","Not Applicable","Not Applicable","$1,000","$2,000","20%",,,,"$2,000","$4,000","Not Applicable","Not Applicable","$0","$0","0%",,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","3","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350001-01","Standard Bronze On Exchange Plan","62.00%","0.620662271976471","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000","$250","$500","50%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","3","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350001-02","Zero Cost Sharing Plan Variation","100.00%","1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","3","31274","WV","Individual","No","55-0624615","31274WV0350001","Comprehensive Care Blue PPO 4000","31274WV035",,"WVN001","WVS001","WVF003","New","PPO","Bronze","Yes","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9954",,,"0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0350001-03","Limited Cost Sharing Plan Variation","62.00%","0.620662271976471","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,000","$8,000","50%",,,,"$8,000","$16,000","$12,000","$24,000","$250","$500","50%",,,,"Not Applicable","Not Applicable","$250","$500",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","4","31274","WV","Individual","No","55-0624615","31274WV0320001","Major Events Blue PPO 6350","31274WV032",,"WVN001","WVS001","WVF001","New","PPO","Catastrophic","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.995",,,"0","0","3","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0320001-01","Standard Catastrophic On Exchange Plan",,,"No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","Not Applicable",,,"$12,700","Not Applicable","$19,050","Not Applicable","$6,350","Not Applicable","0%",,,,"$12,700","Not Applicable","$19,050","Not Applicable","$0","Not Applicable","0%",,,,"$0","Not Applicable","$0","Not Applicable",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","5","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5000","31274WV033",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9956",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330001-01","Standard Bronze On Exchange Plan",,"0.619656085968018","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","5","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5000","31274WV033",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9956",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330001-02","Zero Cost Sharing Plan Variation",,"1","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,,,"$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","5","31274","WV","Individual","No","55-0624615","31274WV0330001","Shared Cost Blue PPO 5000","31274WV033",,"WVN001","WVS001","WVF002","New","PPO","Bronze","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9956",,,"0","0","0","2014-01-01",,"Yes","same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330001-03","Limited Cost Sharing Plan Variation",,"0.619656085968018","Yes","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100",,,,,,,,,,,,,,,,,,,,,"$5,000","$10,000","40%",,,,"$10,000","$20,000","$15,000","$30,000",,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-01","Standard Silver On Exchange Plan",,"0.699447989463806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"4"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"5"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-03","Limited Cost Sharing Plan Variation",,"0.699447989463806","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,350","$12,700",,,"$12,700","$25,400","$19,050","$38,100","$4,750","$9,500","20%",,,,"$9,500","$19,000","$14,250","$28,500","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"6"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-04","73% AV Level Silver Plan",,"0.722866296768188","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$5,200","$10,400",,,"$12,700","$25,400","$17,900","$35,800","$4,000","$8,000","20%",,,,"$9,500","$19,000","$13,500","$27,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"7"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-05","87% AV Level Silver Plan",,"0.87159663438797","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$1,500","$3,000",,,"$12,700","$25,400","$14,200","$28,400","$500","$1,000","10%",,,,"$9,500","$19,000","$10,000","$20,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"8"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330002","Shared Cost Blue PPO 4750","31274WV033",,"WVN001","WVS001","WVF001","New","PPO","Silver","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9961",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330002-06","94% AV Level Silver Plan",,"0.938876569271088","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$500","$1,000",,,"$12,700","$25,400","$13,200","$26,400","$100","$200","10%",,,,"$9,500","$19,000","$9,600","$19,200","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"9"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330003-01","Standard Gold On Exchange Plan",,"0.789091169834137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"10"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330003-02","Zero Cost Sharing Plan Variation",,"1","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$0","$0",,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"11"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330003","Shared Cost Blue PPO 500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330003-03","Limited Cost Sharing Plan Variation",,"0.789091169834137","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$6,000","$12,000",,,"$12,000","$24,000","$18,000","$36,000","$500","$1,000","20%",,,,"$1,000","$2,000","$1,500","$3,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"12"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330004","Shared Cost Blue PPO 1000","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9969",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330004-01","Standard Gold On Exchange Plan",,"0.79634553194046","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,000","$2,000","20%",,,,"$2,000","$4,000","$3,000","$6,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"13"
"2014","WV","31274","SERFF","9","2014-03-14 10:14:14","6","31274","WV","Individual","No","55-0624615","31274WV0330005","Shared Cost Blue PPO 1500","31274WV033",,"WVN001","WVS001","WVF004","New","PPO","Gold","No","On the Exchange","No","No",,,"$0.00","No",,,"Allows Adult and Child-Only",,"Yes","Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy",,"0.9968",,"$200","0","0","0","2014-01-01",,"Yes","Same as in area","Yes","same as in area","Yes","https://www.highmark.com/sbc/bcbswv","https://shop.highmark.com/wcs/x-services/hcr/v1/applicant/payment","http://www.discoverhighmark.com/","http://client.formularynavigator.com/clients/highmark/commercial.html","31274WV0330005-03","Limited Cost Sharing Plan Variation",,"0.78404176235199","No","Yes","No","100%",,,,,,,,,,,,,,,,,,"$3,500","$7,000",,,"$7,000","$14,000","$10,500","$21,000","$1,500","$3,000","20%",,,,"$3,000","$6,000","$4,500","$9,000","$0","$0","0%",,,,"$0","$0","$0","$0",,,,,,,,,,,,,,,,,,,"18"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","Individual","Yes","55-0523124","76526WV0010002","Delta Dental PPO Plan 85 for Children","76526WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010002",,"76526WV0010002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020002",,"76526WV0020002-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020002","Delta Dental PPO Plan 85 for Children for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$18.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020002",,"76526WV0020002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","Individual","Yes","55-0523124","76526WV0010002","Delta Dental PPO Plan 85 for Children","76526WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010002",,"76526WV0010002-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","2","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020006",,"76526WV0020006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","2","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020006","Delta Dental PPO Plan 70 for Children + Basic for Adults for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020006",,"76526WV0020006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","3","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020004",,"76526WV0020004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","3","76526","WV","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","76526WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010006",,"76526WV0010006-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","4","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0040001","Smile for Health Child C60A50","34848WV004",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a50-ppo.pdf",,,,"34848WV0040001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0110001","Guardian Pediatric Essentials","96480WV011",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0110001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","Individual","Yes","55-0523124","76526WV0010001","Delta Dental PPO Plan 70 for Children","76526WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010001",,"76526WV0010001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020001",,"76526WV0020001-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","3","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020004","Delta Dental PPO Plan 85 for Children + Preferred for Adults for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$18.06",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020004",,"76526WV0020004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","3","76526","WV","Individual","Yes","55-0523124","76526WV0010006","Delta Dental PPO Plan 70 for Children + Basic for Adults","76526WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$14.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010006",,"76526WV0010006-01","Standard Low On Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","4","76526","WV","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","76526WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010004",,"76526WV0010004-00","Standard High Off Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","4","76526","WV","Individual","Yes","55-0523124","76526WV0010004","Delta Dental PPO Plan 85 for Children + Preferred for Adults","76526WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010004",,"76526WV0010004-01","Standard High On Exchange Plan","84.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$30","Not Applicable",,,,,"$30","Not Applicable","$30","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0100001","Guardian Pediatric Advantage","96480WV010",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0100001-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0100001","Guardian Pediatric Advantage","96480WV010",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0100001-01","Standard High On Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","4","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0070001","Guardian Family Advantage","96480WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0070001-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","4","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0070001","Guardian Family Advantage","96480WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0070001-01","Standard High On Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","4","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0090001","Guardian Family Essentials","96480WV009",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0090001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","4","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0090001","Guardian Family Essentials","96480WV009",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0090001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","1","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0110001","Guardian Pediatric Essentials","96480WV011",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0110001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0060001","Guardian Family Advantage Plus","96480WV006",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0060001-00","Standard High Off Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","2","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0060001","Guardian Family Advantage Plus","96480WV006",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.74",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0060001-01","Standard High On Exchange Plan","84.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$0","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","3","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0080001","Guardian Family Essentials Plus","96480WV008",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0080001-00","Standard Low Off Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","96480","SERFF","5","2013-09-11 14:31:09","3","96480","WV","SHOP (Small Group)","Yes","13-5123390","96480WV0080001","Guardian Family Essentials Plus","96480WV008",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$17.92",,"Guaranteed Rate",,"0","0","0","2014-01-01",,"No",,"Yes","Coverage is available outside of service area.","Yes","http://www.guardianlife.com/small-business-exchanges/",,"http://www.guardianlife.com/small-business-exchanges/",,"96480WV0080001-01","Standard Low On Exchange Plan","69.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$75","Not Applicable",,,,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","2","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020006",,"53843WV0020006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","3","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.60",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020004",,"53843WV0020004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","3","53843","WV","Individual","Yes","75-1233841","53843WV0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","53843WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010004",,"53843WV0010004-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","3","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.60",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020004",,"53843WV0020004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","3","53843","WV","Individual","Yes","75-1233841","53843WV0010004","Dentegra Dental PPO Children's Plan 85 + Adult Preferred","53843WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$19.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010004",,"53843WV0010004-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","Individual","Yes","55-0523124","76526WV0010001","Delta Dental PPO Plan 70 for Children","76526WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.61",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.deltadentalins.com/hx/checkout","deltadentalins.com/hx/wv/76526wv0010001",,"76526WV0010001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","76526","SERFF","8","2014-01-21 11:24:32","1","76526","WV","SHOP (Small Group)","Yes","55-0523124","76526WV0020001","Delta Dental PPO Plan 70 for Children for Small Businesses","76526WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$14.72",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"deltadentalins.com/hx/wv/76526wv0020001",,"76526WV0020001-00","Standard Low Off Exchange Plan","72.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","4","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0040001","Smile for Health Child C60A50","34848WV004",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Service Area","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a50-ppo.pdf",,,,"34848WV0040001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","4","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0040002","Smile For Health Family C60A50","34848WV004",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a50-ppo.pdf",,,,"34848WV0040002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","1","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0010002","Smile for Health Family C60A70","34848WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a70-ppo.pdf",,,,"34848WV0010002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","1","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0010002","Smile for Health Family C60A70","34848WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same Coverage as In-Service","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a70-ppo.pdf",,,,"34848WV0010002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","3","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0020001","Smile for Health Child C60A60","34848WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a60-ppo.pdf",,,,"34848WV0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","3","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0020001","Smile for Health Child C60A60","34848WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-service network","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c60a60-ppo.pdf",,,,"34848WV0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","3","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0020002","Smile for Health Family C60A60","34848WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a60-ppo.pdf",,,,"34848WV0020002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","3","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0020002","Smile for Health Family C60A60","34848WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as In-Network area","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a60-ppo.pdf",,,,"34848WV0020002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","4","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0040002","Smile For Health Family C60A50","34848WV004",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c60a50-ppo.pdf",,,,"34848WV0040002-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","5","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0100001","Smile for Health Child C80","34848WV010",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0100001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","6","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0070001","Smile for Health Child C80A80","34848WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c80a80-ppo.pdf",,,,"34848WV0070001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","6","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0070001","Smile for Health Child C80A80","34848WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network service area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-child-c80a80-ppo.pdf",,,,"34848WV0070001-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","6","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0070002","Smile for Health Family C80A80","34848WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c80a80-ppo.pdf",,,,"34848WV0070002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","6","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0070002","Smile for Health Family C80A80","34848WV007",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided within the In-network area.","Yes","https://secure.ucci.com/docs/benefits-summary-wv-grp-family-c80a80-ppo.pdf",,,,"34848WV0070002-01","Standard High On Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","7","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0030001","Smile for Health Child C60A80","34848WV003",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0030001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","7","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0030002","Smile for Health Family C60A80","34848WV003",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$43.33",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0030002-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$75","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","8","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0080001","Smile for Health Child C80A50","34848WV008",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0080001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","8","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0080002","Smile for Health Family C80A50","34848WV008",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0080002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","9","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0060001","Smile for Health Child C80A60","34848WV006",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0060001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","9","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0060002","Smile for Health Family C80A60","34848WV006",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0060002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","10","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0050001","Smile for Health Child C80A70","34848WV005",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0050001-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","34848","SERFF","4","2013-09-11 14:31:09","10","34848","WV","SHOP (Small Group)","Yes","86-0307623","34848WV0050002","Smile for Health Family C80A70","34848WV005",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,"1) Cosmetic in nature (for example but not limitation, restorations, bleaching, veneer facings, personalization or characterization of crowns, bridges and/or dentures), 2) The responsibility of Workers� Compensation or employer�s liability insurance, or for treatment of any automobile-related injury in which the Member is entitled to payment under an automobile insurance policy. The Company�s benefits would be in excess to the third-party benefits and therefore, the Company would have right of recovery for any benefits paid in excess.3) For orthodontic Services for individuals/members ages 19 and older or For orthodontic treatment that is not deemed medically necessary for children through the end of the contract year in which they turn 19. For additional detail on full exclusions, please refer to your plan documents.",,,,,"Allows Adult and Child-Only",,,,"$48.79",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","Same coverage as provided in the In-Service area","Yes",,,,,"34848WV0050002-00","Standard High Off Exchange Plan","86.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"Not Applicable","Not Applicable",,,,,"Not Applicable","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","52120","SERFF","1","2013-08-01 21:15:43","1","52120","WV","SHOP (Small Group)","Yes","35-0472300","52120WV0010001","DentalConnect�","52120WV001",,"WVN001","WVS001",,"New","PPO","High",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$27.53",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"52120WV0010001-00","Standard High Off Exchange Plan","83.10%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$25","Not Applicable",,,,,"$25","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","52120","SERFF","1","2013-08-01 21:15:43","1","52120","WV","SHOP (Small Group)","Yes","35-0472300","52120WV0010002","DentalConnect�","52120WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$23.10",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"52120WV0010002-00","Standard Low Off Exchange Plan","71.20%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$200","Not Applicable",,,,,"$200","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","52120","SERFF","1","2013-08-01 21:15:43","2","52120","WV","SHOP (Small Group)","Yes","35-0472300","52120WV0010003","DentalConnect�","52120WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Off the Exchange",,,,,,,,,"Allows Adult and Child-Only",,,,"$21.57",,"Estimated Rate",,"0","0","0","2014-01-01",,"No",,"No",,"Yes",,,,,"52120WV0010003-00","Standard Low Off Exchange Plan","70.40%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","Individual","Yes","75-1233841","53843WV0010001","Dentegra Dental PPO Children's Plan 70","53843WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.57",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010001",,"53843WV0010001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020001",,"53843WV0020001-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020001","Dentegra Dental PPO Children's Plan 70 for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020001",,"53843WV0020001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","Individual","Yes","75-1233841","53843WV0010001","Dentegra Dental PPO Children's Plan 70","53843WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Child-Only",,,,"$15.57",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010001",,"53843WV0010001-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","Individual","Yes","75-1233841","53843WV0010002","Dentegra Dental PPO Children's Plan 85","53843WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010002",,"53843WV0010002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.60",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020002",,"53843WV0020002-00","Standard High Off Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"6"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","Individual","Yes","75-1233841","53843WV0010002","Dentegra Dental PPO Children's Plan 85","53843WV001",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.44",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010002",,"53843WV0010002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","1","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020002","Dentegra Dental PPO Children's Plan 85 for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","High",,"Both",,,,,,,,,"Allows Child-Only",,,,"$19.60",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020002",,"53843WV0020002-01","Standard High On Exchange Plan","85.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$35","Not Applicable",,,,,"$35","Not Applicable","$35","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"7"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","2","53843","WV","Individual","Yes","75-1233841","53843WV0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","53843WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.57",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010006",,"53843WV0010006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","2","53843","WV","SHOP (Small Group)","Yes","75-1233841","53843WV0020006","Dentegra Dental PPO Children's Plan 70 + Adult Basic for Small Businesses","53843WV002",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.69",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,,"dentegra.com/hx/wv/53843wv0020006",,"53843WV0020006-00","Standard Low Off Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"4"
"2014","WV","53843","SERFF","5","2014-01-21 11:24:32","2","53843","WV","Individual","Yes","75-1233841","53843WV0010006","Dentegra Dental PPO Children's Plan 70 + Adult Basic","53843WV001",,"WVN001","WVS001",,"New","PPO","Low",,"Both",,,,,,,,,"Allows Adult and Child-Only",,,,"$15.57",,"Guaranteed Rate",,"0","0","0","2014-01-01","2014-12-31","No",,"Yes","national coverage","Yes",,"www.dentegra.com/hx/checkout","dentegra.com/hx/wv/53843wv0010006",,"53843WV0010006-01","Standard Low On Exchange Plan","71.00%",,,,"No","100%",,"$700","$1,400",,,"Not Applicable","Not Applicable","Not Applicable","Not Applicable",,,,,,,,,,,,,,,,,"$50","Not Applicable",,,,,"$50","Not Applicable","$50","Not Applicable",,,,,,,,,,,,,,,,,,,,,,,,,,,,,"5"